Individual
STEPHANIE PARKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-5710
Mailing address
830 WASHINGTON ST, WATERTOWN, NY 13601-4034
(315) 785-4088
(315) 786-4847
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
008496
NY
225200000X
Physical Therapy Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008496
LICENSE
NY
01
—
P84057
PERMIT
NY
Enumeration date
06/18/2012
Last updated
08/03/2012
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