Provider Demographics
NPI:1295505105
Name:MARK, ANDREW (DPT)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:MARK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4848 E ROOSEVELT ST APT 3011
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85008-7338
Mailing Address - Country:US
Mailing Address - Phone:717-679-8299
Mailing Address - Fax:
Practice Address - Street 1:3501 W OSBORN RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85019-4037
Practice Address - Country:US
Practice Address - Phone:602-272-7676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-03
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic