Provider Demographics
NPI:1538283312
Name:STUTZ, MARK (PHD, LAT, ATC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:STUTZ
Suffix:
Gender:M
Credentials:PHD, LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2102 ALLEN STREET
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-4354
Mailing Address - Fax:
Practice Address - Street 1:2102 ALLEN ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2833
Practice Address - Country:US
Practice Address - Phone:785-628-4354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24-00K1102255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer