Provider Demographics
NPI:1639549074
Name:TATTERSALL, MARK A (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:TATTERSALL
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 1:2276 BIRCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-2605
Mailing Address - Country:US
Mailing Address - Phone:814-602-9660
Mailing Address - Fax:
Practice Address - Street 1:24400 HIGHPOINT RD
Practice Address - Street 2:SUITE 10
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-6054
Practice Address - Country:US
Practice Address - Phone:216-896-0824
Practice Address - Fax:216-896-0825
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT016078225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist