Provider Demographics
NPI:1104043728
Name:BRESEE, MARK CHAPIN (MPT, OCS)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHAPIN
Last Name:BRESEE
Suffix:
Gender:M
Credentials:MPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 AIR PARK RD
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-7022
Mailing Address - Country:US
Mailing Address - Phone:662-842-2100
Mailing Address - Fax:662-842-2105
Practice Address - Street 1:600 AIR PARK RD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-7022
Practice Address - Country:US
Practice Address - Phone:662-842-2100
Practice Address - Fax:662-842-2105
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSPT3201225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS1407915754OtherNPI FOR MY S-CORPORATION