Provider Demographics
NPI:1467425694
Name:STOCKMAN, MARK JAY (MSPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JAY
Last Name:STOCKMAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:147 EASY WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-8105
Mailing Address - Country:US
Mailing Address - Phone:509-663-7733
Mailing Address - Fax:509-663-3255
Practice Address - Street 1:147 EASY WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-8105
Practice Address - Country:US
Practice Address - Phone:509-663-7733
Practice Address - Fax:509-663-3255
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00005154225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist