Provider Demographics
NPI:1568473585
Name:MASCIO, MARK W (LPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:MASCIO
Suffix:
Gender:M
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 PENCO RD
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062
Mailing Address - Country:US
Mailing Address - Phone:304-723-3780
Mailing Address - Fax:304-723-4110
Practice Address - Street 1:414 PENCO RD
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062
Practice Address - Country:US
Practice Address - Phone:304-723-3780
Practice Address - Fax:304-723-4110
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT007090225100000X
PAPT006827L225100000X
WV001071225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV55071930003OtherTHE HEALTH PLAN BWC
WV000745332OtherBLUE CROSS/BLUE SHIELD
WV151547300OtherUS DEPT OF LABOR
WV55071930000OtherWV WORKERS COMP BRICKSTRE
WV0156598000Medicaid
WV0735033Medicare PIN