Provider Demographics
NPI:1023421047
Name:HRUSKA, MARK DAVID (PTA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DAVID
Last Name:HRUSKA
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:844 SMOKETREE CT
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4980
Mailing Address - Country:US
Mailing Address - Phone:760-845-4733
Mailing Address - Fax:
Practice Address - Street 1:5810 EL CAMINO REAL
Practice Address - Street 2:SUITE C
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8819
Practice Address - Country:US
Practice Address - Phone:760-603-9166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT 6344225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant