Provider Demographics
NPI:1306391628
Name:NEARHOOD, MARK (PT,DPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:NEARHOOD
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 1:2316 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14301-2338
Mailing Address - Country:US
Mailing Address - Phone:716-284-4474
Mailing Address - Fax:716-284-4844
Practice Address - Street 1:2316 PINE AVE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14301-2338
Practice Address - Country:US
Practice Address - Phone:716-284-4474
Practice Address - Fax:716-284-4844
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-16
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY62 040585225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist