Provider Demographics
NPI:1275239881
Name:TIELEMAN, MARK (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:TIELEMAN
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8470 LIMEKILN PIKE
Mailing Address - Street 2:APARTMENT 515, BUILDING 2
Mailing Address - City:WYNCOTE
Mailing Address - State:PA
Mailing Address - Zip Code:19095
Mailing Address - Country:US
Mailing Address - Phone:201-370-8703
Mailing Address - Fax:
Practice Address - Street 1:518 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:EMMAUS
Practice Address - State:PA
Practice Address - Zip Code:18049-2404
Practice Address - Country:US
Practice Address - Phone:484-522-5350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-06
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT031062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist