Provider Demographics
NPI:1225592553
Name:PARKER, MARIA SOCORRO BUENVIAJE (ATC)
Entity type:Individual
Prefix:
First Name:MARIA SOCORRO
Middle Name:BUENVIAJE
Last Name:PARKER
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:MAISY
Other - Middle Name:BUENVIAJE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ATC
Mailing Address - Street 1:423 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:CO
Mailing Address - Zip Code:81226-1506
Mailing Address - Country:US
Mailing Address - Phone:573-692-6815
Mailing Address - Fax:
Practice Address - Street 1:423 E 3RD ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:CO
Practice Address - Zip Code:81226-1506
Practice Address - Country:US
Practice Address - Phone:573-692-6815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-31
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAT.00022202255A2300X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer