Provider Demographics
NPI:1700854304
Name:LINANE, MARK ANTHONY (PT, MS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:LINANE
Suffix:
Gender:M
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1125 RAINTREE CIR STE 100
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5289
Mailing Address - Country:US
Mailing Address - Phone:972-727-9995
Mailing Address - Fax:972-727-8350
Practice Address - Street 1:1125 RAINTREE CIR STE 100
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5289
Practice Address - Country:US
Practice Address - Phone:972-727-9995
Practice Address - Fax:972-727-8350
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10598222251X0800X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX85589TOtherBLUE CROSS BLUE SHIELD
TX854T82OtherBC/BS TX - EFFECT. 02/01/2011
TX4363236OtherAETNA HEALTHCARE
TX4363236OtherAETNA HEALTHCARE
TX85589TOtherBLUE CROSS BLUE SHIELD
TX85589TOtherBLUE CROSS BLUE SHIELD