Provider Demographics
NPI:1811400807
Name:YAROSZ, MARK E (MS, PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:E
Last Name:YAROSZ
Suffix:
Gender:M
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 STONEGATE DR
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-8585
Mailing Address - Country:US
Mailing Address - Phone:219-929-6463
Mailing Address - Fax:
Practice Address - Street 1:55 UNIVERSITY DR STE 106
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-2196
Practice Address - Country:US
Practice Address - Phone:219-464-8302
Practice Address - Fax:219-531-1825
Is Sole Proprietor?:No
Enumeration Date:2017-11-13
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05006850A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist