Provider Demographics
NPI:1184642878
Name:ANSBROW, MARK LEONARD (PT OCS)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:LEONARD
Last Name:ANSBROW
Suffix:
Gender:M
Credentials:PT OCS
Other - Prefix:
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Mailing Address - Street 1:118 HIDDEN BLUFF LN
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513-5708
Mailing Address - Country:US
Mailing Address - Phone:919-380-8037
Mailing Address - Fax:
Practice Address - Street 1:3320 EXECUTIVE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-7445
Practice Address - Country:US
Practice Address - Phone:919-872-3747
Practice Address - Fax:919-872-3414
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC9699225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCPENDINGMedicaid
NC079GWOtherBCBS
NCPENDINGMedicaid