Provider Demographics
NPI:1215120407
Name:PARKS, LYNDA MARIE (DPT)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:MARIE
Last Name:PARKS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:LYNDA
Other - Middle Name:MARIE
Other - Last Name:BARNHART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:129 S PEBBLE BEACH BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5718
Mailing Address - Country:US
Mailing Address - Phone:813-633-6800
Mailing Address - Fax:813-633-6801
Practice Address - Street 1:129 S PEBBLE BEACH BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5718
Practice Address - Country:US
Practice Address - Phone:813-633-6800
Practice Address - Fax:813-633-6801
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-22
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP11153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3400047Medicaid