Provider Demographics
NPI:1588484968
Name:PARKER, KEITH II (LMT, CMNT)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:
Last Name:PARKER
Suffix:II
Gender:M
Credentials:LMT, CMNT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2902 AIRPORT RD APT 103
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3052
Mailing Address - Country:US
Mailing Address - Phone:910-709-4187
Mailing Address - Fax:
Practice Address - Street 1:2902 AIRPORT RD APT 103
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3052
Practice Address - Country:US
Practice Address - Phone:910-709-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT.0025458225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist