Provider Demographics
NPI:1730428970
Name:PARKS, JOHN ROBERT JR (LMT)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT
Last Name:PARKS
Suffix:JR
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 S OLD SEVIERVILLE PIKE
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-4146
Mailing Address - Country:US
Mailing Address - Phone:702-834-1335
Mailing Address - Fax:
Practice Address - Street 1:436 PARK RD
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-4128
Practice Address - Country:US
Practice Address - Phone:865-505-0636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNVMT.4647225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist