Provider Demographics
NPI:1164454062
Name:SCHUKMAN, MARK G (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:G
Last Name:SCHUKMAN
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 1:11418 W 132ND CT
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-1159
Mailing Address - Country:US
Mailing Address - Phone:913-307-6727
Mailing Address - Fax:
Practice Address - Street 1:11418 W 132ND CT
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-1159
Practice Address - Country:US
Practice Address - Phone:913-307-6727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011010353225100000X
KS11-00724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist