Provider Demographics
NPI:1336252527
Name:HARDISKY, MARK JOSEPH (MPT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:JOSEPH
Last Name:HARDISKY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 MARSH RD
Mailing Address - Street 2:STORE 505
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4581
Mailing Address - Country:US
Mailing Address - Phone:302-793-0432
Mailing Address - Fax:302-793-0400
Practice Address - Street 1:3465 BOX HILL CORP CTR DR
Practice Address - Street 2:STE G
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1261
Practice Address - Country:US
Practice Address - Phone:410-563-4806
Practice Address - Fax:410-569-5474
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19927225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
014156OtherJOHNS HOPKINS
5070-0057OtherCARE FIRST
3316661000OtherAMERIHEALTH IBC
88760514OtherCARE FIRST
$$$$$$$$$OtherTRICARE CHAMPUS
5070-0057OtherCARE FIRST
88760514OtherCARE FIRST
014156OtherJOHNS HOPKINS
MD313PS044Medicare PIN