Provider Demographics
NPI:1659606564
Name:MCLAUGHLIN, MARK (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:
Last Name:MCLAUGHLIN
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 1:3488 E LAKE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-2404
Mailing Address - Country:US
Mailing Address - Phone:727-846-0547
Mailing Address - Fax:
Practice Address - Street 1:5515 GULF DR
Practice Address - Street 2:SUITE A
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4033
Practice Address - Country:US
Practice Address - Phone:727-846-0547
Practice Address - Fax:727-847-0755
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24416225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106811Medicare PIN