Provider Demographics
NPI:1609928944
Name:SCHORN, MARK DAVID (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:SCHORN
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 1:9419 COPPERTOP LOOP NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-3647
Mailing Address - Country:US
Mailing Address - Phone:206-842-2428
Mailing Address - Fax:206-842-2890
Practice Address - Street 1:9419 COPPERTOP LOOP NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-3647
Practice Address - Country:US
Practice Address - Phone:206-842-2428
Practice Address - Fax:206-842-2890
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00002906225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0200505OtherWA. LABOR AND INDUSTRY
WA8346496Medicaid
WAG8873579Medicare PIN