Provider Demographics
NPI:1508972407
Name:NETZINGER, MARK A (RPT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:NETZINGER
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18415 NE HWY 65
Mailing Address - Street 2:
Mailing Address - City:CEDAR
Mailing Address - State:MN
Mailing Address - Zip Code:55011
Mailing Address - Country:US
Mailing Address - Phone:763-413-0880
Mailing Address - Fax:763-413-0850
Practice Address - Street 1:18415 NE HWY 65
Practice Address - Street 2:
Practice Address - City:CEDAR
Practice Address - State:MN
Practice Address - Zip Code:55011
Practice Address - Country:US
Practice Address - Phone:763-413-0880
Practice Address - Fax:763-413-0850
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1981225100000X
WI3582024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN04T14NEOtherBLUE CROSS
51118OtherHEALTH PARTNERS
MN6409001OtherMEDICA
MN6409001OtherMEDICA