Provider Demographics
NPI:1760426332
Name:BONCSER, MARK (MSPT,OCS,FAAOMPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BONCSER
Suffix:
Gender:M
Credentials:MSPT,OCS,FAAOMPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 TRAWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79935-3020
Mailing Address - Country:US
Mailing Address - Phone:915-595-3535
Mailing Address - Fax:915-595-3922
Practice Address - Street 1:836 E REDD RD
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-7221
Practice Address - Country:US
Practice Address - Phone:915-845-4060
Practice Address - Fax:915-845-4065
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1062586225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611248Medicare PIN