Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 006600 | NY |
Y | 225100000X | Physical Therapist | PT001266E | PA |
NPI | 1003058413 |
---|---|
Provider Name | Mr. Mark R Kresse |
First Address | Erie, PA 16508-2903 |
Second Address | Erie, PA 16508-2903 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2009 |
Last Update Date | 31/03/2009 |