Provider Demographics
NPI:1538310529
Name:MCINTOSH, MARK E (MSPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MCINTOSH
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:5922 BARKLEY ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:KS
Mailing Address - Zip Code:66202-3269
Mailing Address - Country:US
Mailing Address - Phone:913-229-9440
Mailing Address - Fax:913-229-9441
Practice Address - Street 1:5922 BARKLEY ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66202-3269
Practice Address - Country:US
Practice Address - Phone:913-229-9440
Practice Address - Fax:913-229-9441
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-040832251X0800X
MO20090238992251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic