Provider Demographics
NPI:1972956910
Name:CLINE, MARK (LMT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:CLINE
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:546 PARK ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1780
Mailing Address - Country:US
Mailing Address - Phone:270-745-9399
Mailing Address - Fax:
Practice Address - Street 1:546 PARK ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-1780
Practice Address - Country:US
Practice Address - Phone:270-745-9399
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-14
Last Update Date:2016-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106276225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist