Provider Demographics
NPI:1982646964
Name:CREGLE, MARK ANDREW (PT)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:CREGLE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1650 LYNDON FARM CT STE 300
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-5005
Mailing Address - Country:US
Mailing Address - Phone:856-463-3052
Mailing Address - Fax:812-590-8333
Practice Address - Street 1:2123 ROUTE 35
Practice Address - Street 2:
Practice Address - City:SEA GIRT
Practice Address - State:NJ
Practice Address - Zip Code:08750-1003
Practice Address - Country:US
Practice Address - Phone:732-449-2001
Practice Address - Fax:732-449-2238
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
COPTL.0004848225100000X
WYPT-0495225100000X
MAPTL9444225100000X
PAPT002970E225100000X
UT274690-2401225100000X
AZLPT-002845225100000X
CT5183225100000X
NJ40QA00646600225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ104366Medicare PIN