Provider Demographics
NPI:1386647741
Name:HOWARD, MARK E (PT,DPT,OCS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PT,DPT,OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4721 TRANSIT RD
Mailing Address - Street 2:STE B
Mailing Address - City:DEPEW
Mailing Address - State:NY
Mailing Address - Zip Code:14043-4898
Mailing Address - Country:US
Mailing Address - Phone:716-675-4444
Mailing Address - Fax:716-675-4446
Practice Address - Street 1:4721 TRANSIT RD
Practice Address - Street 2:STE B
Practice Address - City:DEPEW
Practice Address - State:NY
Practice Address - Zip Code:14043-4898
Practice Address - Country:US
Practice Address - Phone:716-675-4444
Practice Address - Fax:716-675-4446
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009241225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY650018170OtherRAILROAD MEDICARE
NY809602OtherACN
NY00011174401OtherUNIVERA
NY000610297001OtherBLUE CROSS
NY9308094OtherINDEPENDENT HEALTH
NYBB5173Medicare ID - Type Unspecified