Provider Demographics
NPI:1326034299
Name:READ, MARK A (LPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:READ
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8849 WHITNEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEWIS CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:43035-7107
Mailing Address - Country:US
Mailing Address - Phone:740-549-7041
Mailing Address - Fax:740-549-7045
Practice Address - Street 1:8849 WHITNEY DRIVE
Practice Address - Street 2:
Practice Address - City:LEWIS CENTER
Practice Address - State:OH
Practice Address - Zip Code:43035-7107
Practice Address - Country:US
Practice Address - Phone:740-549-7041
Practice Address - Fax:740-549-7045
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT 0042532251S0007X, 2251X0800X
OHPT0042532251S0007X, 2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2284353Medicaid
OH2284353Medicaid