Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251S0007X | Physical Therapist - Sports | AT19 | OK |
Y | 2251X0800X | Physical Therapist - Orthopedic | PT1084 | OK |
NPI | 1053319194 |
---|---|
Provider Name | Mr. Mark S. Cranston |
First Address | Okc, OK 73131-1812 |
Second Address | Okc, OK 73131-1812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2005 |
Last Update Date | 19/12/2011 |