Provider Demographics
NPI:1194890186
Name:MARK S. PLANTE
Entity type:Organization
Organization Name:MARK S. PLANTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PLANTE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:928-343-7828
Mailing Address - Street 1:381 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-2340
Mailing Address - Country:US
Mailing Address - Phone:928-343-7828
Mailing Address - Fax:
Practice Address - Street 1:381 S MAIN ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-2340
Practice Address - Country:US
Practice Address - Phone:928-343-7828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ=========OtherTAX ID