Provider Demographics
NPI:1821342197
Name:MACKEY, MARK E (LMT, CNMT, CST)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MACKEY
Suffix:
Gender:M
Credentials:LMT, CNMT, CST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446-1732
Mailing Address - Country:US
Mailing Address - Phone:215-237-5586
Mailing Address - Fax:
Practice Address - Street 1:119 SUNSET DR
Practice Address - Street 2:
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446-1732
Practice Address - Country:US
Practice Address - Phone:215-237-5586
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG001626225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist