Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | PTA-01827 | OH |
NPI | 1013117662 |
---|---|
Provider Name | Mr. Mark A Phillips |
First Address | Mansfield, OH 44905-1635 |
Second Address | Bucyrus, OH 44820-8509 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2007 |
Last Update Date | 07/07/2008 |