Provider Demographics
NPI:1669479754
Name:STAPLES, MARK FRANKLIN (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:FRANKLIN
Last Name:STAPLES
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 1:1594 BERI BARFIELD DR
Mailing Address - Street 2:
Mailing Address - City:DADEVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36853-4808
Mailing Address - Country:US
Mailing Address - Phone:256-285-7456
Mailing Address - Fax:
Practice Address - Street 1:1120 AIRPORT DR
Practice Address - Street 2:STE 103
Practice Address - City:ALEXANDER CITY
Practice Address - State:AL
Practice Address - Zip Code:35010-3444
Practice Address - Country:US
Practice Address - Phone:256-329-8180
Practice Address - Fax:256-329-8116
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH 1013225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL510-77002OtherBCBS
AL510-77002OtherBCBS