Provider Demographics
NPI:1740398841
Name:CLEVEN, MARK DANIEL (PT, ATC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DANIEL
Last Name:CLEVEN
Suffix:
Gender:M
Credentials:PT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 SE BISHOP BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99163-5534
Mailing Address - Country:US
Mailing Address - Phone:509-332-7778
Mailing Address - Fax:509-332-7032
Practice Address - Street 1:588 SE BISHOP BLVD STE A
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99163-5534
Practice Address - Country:US
Practice Address - Phone:509-332-7778
Practice Address - Fax:509-332-7032
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00003333225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA119067OtherLABOR AND INDUSTRY
WA119067OtherLABOR AND INDUSTRY