Provider Demographics
NPI:1083047435
Name:JASKOWSKI, MARK (PT, DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:JASKOWSKI
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:MOORESTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08057-3851
Mailing Address - Country:US
Mailing Address - Phone:609-870-7579
Mailing Address - Fax:
Practice Address - Street 1:100 CREEK CROSSING BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:HAINESPORT
Practice Address - State:NJ
Practice Address - Zip Code:08036-2765
Practice Address - Country:US
Practice Address - Phone:609-265-0708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01502900225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist