Provider Demographics
NPI:1164600326
Name:KANE, MARK (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:KANE
Suffix:
Gender:M
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 ESTATES AVE
Mailing Address - Street 2:#1111
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-0214
Mailing Address - Country:US
Mailing Address - Phone:704-307-9677
Mailing Address - Fax:
Practice Address - Street 1:1450 ESTATES AVE
Practice Address - Street 2:#1111
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-0214
Practice Address - Country:US
Practice Address - Phone:704-307-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-09
Last Update Date:2008-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5349225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist