Provider Demographics
NPI:1265699284
Name:JUARIO, MARK (P,T)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JUARIO
Suffix:
Gender:M
Credentials:P,T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 357279
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32635-7279
Mailing Address - Country:US
Mailing Address - Phone:352-373-7984
Mailing Address - Fax:352-332-3812
Practice Address - Street 1:3305 SW 34TH CIR
Practice Address - Street 2:SUITE 203
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-6616
Practice Address - Country:US
Practice Address - Phone:352-351-5019
Practice Address - Fax:352-351-5236
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT23756225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAW650ZMedicare PIN