Provider Demographics
NPI:1467409482
Name:LLEWELLYN, MARK ANDREW (MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANDREW
Last Name:LLEWELLYN
Suffix:
Gender:M
Credentials:MPT
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Mailing Address - Street 1:PO BOX 20687
Mailing Address - Street 2:ST LUKES PHYSICAL THERAPY
Mailing Address - City:LEHIGH VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18002-0687
Mailing Address - Country:US
Mailing Address - Phone:484-851-3386
Mailing Address - Fax:484-851-3469
Practice Address - Street 1:495 BUSHKILL PLAZA LANE
Practice Address - Street 2:ST LUKES PHYSICAL THERAPY
Practice Address - City:WIND GAP
Practice Address - State:PA
Practice Address - Zip Code:18091-9665
Practice Address - Country:US
Practice Address - Phone:610-863-0601
Practice Address - Fax:610-863-3258
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAPT015381225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA03003002OtherCAPITAL
PALL1322070OtherHIGHMARK