Provider Demographics
NPI:1558675405
Name:HAITH, MARK ANTHONY (DPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:HAITH
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5111 CALEDONIA RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-3005
Mailing Address - Country:US
Mailing Address - Phone:804-291-8679
Mailing Address - Fax:
Practice Address - Street 1:5001 W VILLAGE GREEN DR
Practice Address - Street 2:SUITE 203
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-4801
Practice Address - Country:US
Practice Address - Phone:804-249-8277
Practice Address - Fax:804-249-9690
Is Sole Proprietor?:No
Enumeration Date:2010-08-03
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305206587225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist