Provider Demographics
NPI:1750821260
Name:MASALSKIS, MARK (ATC, LAT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MASALSKIS
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 DUTCH MILL DR
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011-3564
Mailing Address - Country:US
Mailing Address - Phone:314-686-3644
Mailing Address - Fax:
Practice Address - Street 1:800 UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:MO
Practice Address - Zip Code:64468-6015
Practice Address - Country:US
Practice Address - Phone:660-562-1212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026274390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program