Provider Demographics
NPI:1548890064
Name:PARENT, PHYLLIS A (PT)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:A
Last Name:PARENT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1554 SYLVAN WAY
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:CA
Mailing Address - Zip Code:95969-4324
Mailing Address - Country:US
Mailing Address - Phone:530-327-8510
Mailing Address - Fax:
Practice Address - Street 1:6460 PENTZ RD STE C
Practice Address - Street 2:
Practice Address - City:PARADISE
Practice Address - State:CA
Practice Address - Zip Code:95969-3673
Practice Address - Country:US
Practice Address - Phone:530-762-0473
Practice Address - Fax:530-762-0473
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty