Provider Demographics
NPI:1043596679
Name:MARK, ANTHONY MICHAEL (DPT)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:MICHAEL
Last Name:MARK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1201 TERRY AVE
Mailing Address - Street 2:MAILSTOP: X2-SM
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-2735
Mailing Address - Country:US
Mailing Address - Phone:206-223-7528
Mailing Address - Fax:206-223-7577
Practice Address - Street 1:1201 TERRY AVE
Practice Address - Street 2:MAILSTOP: X2-SM
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-2735
Practice Address - Country:US
Practice Address - Phone:206-223-7528
Practice Address - Fax:206-223-7577
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2011-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT602282892081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine