Provider Demographics
NPI:1770028060
Name:FERRER, MARK FRANCIS DELA CRUZ JR (DPT)
Entity Type:Individual
Prefix:
First Name:MARK FRANCIS
Middle Name:DELA CRUZ
Last Name:FERRER
Suffix:JR
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1275 W PUEBLO BLVD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3866
Mailing Address - Country:US
Mailing Address - Phone:719-542-0589
Mailing Address - Fax:719-542-0119
Practice Address - Street 1:900 W ABRIENDO AVE
Practice Address - Street 2:APT 107A
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-1141
Practice Address - Country:US
Practice Address - Phone:719-421-9266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012142225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist