Provider Demographics
NPI:1710066659
Name:HOARD, MARK BRADLEY (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:BRADLEY
Last Name:HOARD
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:14130 COUNTY ROAD 25
Mailing Address - Street 2:
Mailing Address - City:BRAINERD
Mailing Address - State:MN
Mailing Address - Zip Code:56401-5060
Mailing Address - Country:US
Mailing Address - Phone:320-293-4029
Mailing Address - Fax:
Practice Address - Street 1:2016 S 6TH ST
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-4529
Practice Address - Country:US
Practice Address - Phone:218-828-7375
Practice Address - Fax:218-825-7379
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN4827225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist