Provider Demographics
NPI:1477612497
Name:ALBERT, MARK S (PT, SCS, ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:ALBERT
Suffix:
Gender:M
Credentials:PT, SCS, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47110 WASHINGTON ST
Mailing Address - Street 2:SUITE # 103
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-2186
Mailing Address - Country:US
Mailing Address - Phone:760-972-4580
Mailing Address - Fax:760-625-1650
Practice Address - Street 1:47110 WASHINGTON ST
Practice Address - Street 2:SUITE # 103
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2186
Practice Address - Country:US
Practice Address - Phone:760-972-4580
Practice Address - Fax:760-625-1650
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26714225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist