Provider Demographics
NPI:1144208802
Name:HUGHES, MARK GREGORY (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:GREGORY
Last Name:HUGHES
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 1:420 FOREST RD
Mailing Address - Street 2:
Mailing Address - City:ACME
Mailing Address - State:PA
Mailing Address - Zip Code:15610-1218
Mailing Address - Country:US
Mailing Address - Phone:724-547-3657
Mailing Address - Fax:724-547-5586
Practice Address - Street 1:3802 STATE ROUTE 31
Practice Address - Street 2:SUITE 2
Practice Address - City:DONEGAL
Practice Address - State:PA
Practice Address - Zip Code:15628-4033
Practice Address - Country:US
Practice Address - Phone:724-593-8880
Practice Address - Fax:724-593-8882
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015390225100000X
PADAPT000654225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
230375OtherHEALTH ASSURANCE/AMERICA
PA001860740 0024Medicaid
PA1324377OtherHIGHMARK BC BS
7911302OtherAETNA PPO
3492992OtherAETNA HMO
Q04586Medicare UPIN
075782Medicare ID - Type Unspecified