Provider Demographics
NPI:1275050114
Name:SHEARER, MARK OTIS (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:OTIS
Last Name:SHEARER
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 1:603 ROSARY DR
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:IA
Mailing Address - Zip Code:50841-1683
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:603 ROSARY DR
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:IA
Practice Address - Zip Code:50841-1683
Practice Address - Country:US
Practice Address - Phone:641-322-3121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3026225100000X
IA004837225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist