Provider Demographics
NPI:1801965074
Name:GREENSPAN, MARK (MSPT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:GREENSPAN
Suffix:
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 CRESCENT CENTRE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-7285
Mailing Address - Country:US
Mailing Address - Phone:615-416-0199
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:930 WOODSTOCK RD STE 310
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-2220
Practice Address - Country:US
Practice Address - Phone:770-998-6636
Practice Address - Fax:770-998-6646
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPT006319225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA006319OtherSTATE LISC NUMBER