Provider Demographics
NPI:1225208556
Name:MCBRIDE, MARK BRANDON (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRANDON
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4621 W PARK BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2318
Mailing Address - Country:US
Mailing Address - Phone:972-985-1776
Mailing Address - Fax:972-985-6088
Practice Address - Street 1:4621 W PARK BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-2318
Practice Address - Country:US
Practice Address - Phone:972-985-1776
Practice Address - Fax:972-985-6088
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH52572251X0800X
TX1197899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic