Provider Demographics
NPI:1386634962
Name:HUSSING, MARK C (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:HUSSING
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266-3218
Mailing Address - Country:US
Mailing Address - Phone:330-297-9020
Mailing Address - Fax:330-297-9095
Practice Address - Street 1:1850 SR 59
Practice Address - Street 2:STE B
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240
Practice Address - Country:US
Practice Address - Phone:330-676-9544
Practice Address - Fax:330-676-9547
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT04916225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPT04916OtherOHIO OT PT ATC BOARD