Provider Demographics
NPI:1033321625
Name:MACGREGOR, MARK R (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:R
Last Name:MACGREGOR
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 1:3010 HUNTERS CREEK BLVD STE 100A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6968
Mailing Address - Country:US
Mailing Address - Phone:407-601-3922
Mailing Address - Fax:407-601-3934
Practice Address - Street 1:3010 HUNTERS CREEK BLVD
Practice Address - Street 2:SUITE 100A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6968
Practice Address - Country:US
Practice Address - Phone:407-601-3922
Practice Address - Fax:407-601-3934
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT19635225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAK272ZOtherMEDICARE IND PROVIDER NUMBER
FLK7991OtherMEDICARE GROUP