Provider Demographics
NPI:1326653569
Name:PRADO, MARK (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:PRADO
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 E BIRCH AVE APT 111
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3825
Mailing Address - Country:US
Mailing Address - Phone:408-206-2257
Mailing Address - Fax:
Practice Address - Street 1:7265 N 1ST ST STE 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-2956
Practice Address - Country:US
Practice Address - Phone:559-431-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA299123225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist