Provider Demographics
NPI:1275819542
Name:DRISCOLL, MARK (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:411 THEODORE FREMD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-1410
Mailing Address - Country:US
Mailing Address - Phone:914-921-6061
Mailing Address - Fax:914-921-6075
Practice Address - Street 1:15 N BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-2214
Practice Address - Country:US
Practice Address - Phone:914-686-3132
Practice Address - Fax:914-686-3312
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY021023-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist