Provider Demographics
NPI:1578631354
Name:SHOCH, MARK E (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:SHOCH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N 5TH ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:SUNBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17801-2000
Mailing Address - Country:US
Mailing Address - Phone:570-286-7462
Mailing Address - Fax:570-286-1117
Practice Address - Street 1:309 N 5TH ST
Practice Address - Street 2:SUITE E
Practice Address - City:SUNBURY
Practice Address - State:PA
Practice Address - Zip Code:17801-2000
Practice Address - Country:US
Practice Address - Phone:570-286-7462
Practice Address - Fax:570-286-1117
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT011816L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50064080OtherCAPITAL-KHPC
PASH1914734OtherHIGHMARK BLUE SHIELD
PA457547OtherHEALTH AMER.HEALTH ASSUR
PA50064080OtherCAPITAL-KHPC