Provider Demographics
NPI:1003955915
Name:WORLEY, MARK (PT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:WORLEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 MIDWESTERN PKWY
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-2211
Mailing Address - Country:US
Mailing Address - Phone:940-322-0771
Mailing Address - Fax:940-766-4943
Practice Address - Street 1:1005 MIDWESTERN PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76302-2211
Practice Address - Country:US
Practice Address - Phone:940-322-0771
Practice Address - Fax:940-766-4943
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1168977225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0944746-02Medicaid
TX0031DGOtherBLUE CROSS BLUE SHIELD
TX0031DGOtherBLUE CROSS BLUE SHIELD