Provider Demographics
NPI:1043464548
Name:CLAUSEN, MARK BOYD (LMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BOYD
Last Name:CLAUSEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 S LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:EAST ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14445-1615
Mailing Address - Country:US
Mailing Address - Phone:585-739-3117
Mailing Address - Fax:
Practice Address - Street 1:905 S LINCOLN RD
Practice Address - Street 2:
Practice Address - City:EAST ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14445-1615
Practice Address - Country:US
Practice Address - Phone:585-739-3117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-11
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022360-1225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist