Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | PT 004253 | OH |
Y | 2251S0007X | Physical Therapist - Sports | PT004253 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT 004253 | OH |
N | 2251X0800X | Physical Therapist - Orthopedic | PT004253 | OH |
NPI | 1326034299 |
---|---|
Provider Name | Mr. Mark A Read |
First Address | Lewis Center, OH 43035-7107 |
Second Address | Lewis Center, OH 43035-7107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2005 |
Last Update Date | 03/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2284353 | (05) | OH |
RE0715082 | (02) | OH |