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1003484411
THAYNE MADSEN PARKER
ERIE, PA
NPI
1003484411
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
390200000X Student in an Organized Health Care Education/Training Program
(Licence: PA OT020988)
Enumeration Date
2021-06-12
Last Update Date
2021-06-12
Business Address
THAYNE MADSEN PARKER DO
5515 PEACH ST
ERIE, PA 16509-2603
Phone number: 702-338-5545
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Mailing Address
THAYNE MADSEN PARKER DO
4090 BLACKBERRY LN
ERIE, PA 16506-1764
Phone number: 702-338-5545
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