Provider Demographics
NPI:1740284629
Name:MARKS, PAUL E (PT)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:E
Last Name:MARKS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2311 WAKARUSA DR
Mailing Address - Street 2:STE E
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3350
Mailing Address - Country:US
Mailing Address - Phone:785-856-9966
Mailing Address - Fax:785-856-9967
Practice Address - Street 1:2311 WAKARUSA DR
Practice Address - Street 2:STE E
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3350
Practice Address - Country:US
Practice Address - Phone:785-856-9966
Practice Address - Fax:785-856-9967
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11 02584225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS954896578OtherTAX ID
KS115594OtherBC/BS OF KS GROUP #
KSP00117292OtherRAILROAD MEDICARE
KS100452970AMedicaid
KS140485OtherBC/ BS OF KS #
KS140485Medicare ID - Type Unspecified
KS100452970AMedicaid