Provider Demographics
NPI:1861620304
Name:PARKS, JANET J (PT)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:J
Last Name:PARKS
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 1:10 HIGGINS HWY S
Mailing Address - Street 2:SUITE 12
Mailing Address - City:MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06250-1437
Mailing Address - Country:US
Mailing Address - Phone:860-456-3772
Mailing Address - Fax:860-456-4941
Practice Address - Street 1:10 HIGGINS HWY S
Practice Address - Street 2:SUITE 12
Practice Address - City:MANSFIELD
Practice Address - State:CT
Practice Address - Zip Code:06250-1437
Practice Address - Country:US
Practice Address - Phone:860-456-3772
Practice Address - Fax:860-456-4941
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001095225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist