Provider Demographics
NPI:1194835074
Name:OKEEFE, MARK ANTHONY (PT, DPT, MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:OKEEFE
Suffix:
Gender:M
Credentials:PT, DPT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10704 RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5788
Mailing Address - Country:US
Mailing Address - Phone:806-773-5941
Mailing Address - Fax:
Practice Address - Street 1:10704 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5788
Practice Address - Country:US
Practice Address - Phone:806-773-5941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX190876601Medicaid
TX8J7609Medicare PIN
TXTXB125453Medicare PIN