Provider Demographics
NPI:1912965948
Name:PFEIL, MARK S (PT)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:PFEIL
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 1:2021 CHURCH ST
Mailing Address - Street 2:MEDICAL PLAZA 2 SUITE 106
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2021
Mailing Address - Country:US
Mailing Address - Phone:615-342-0246
Mailing Address - Fax:615-342-0246
Practice Address - Street 1:1334 MILLER ROAD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-4816
Practice Address - Country:US
Practice Address - Phone:615-342-0246
Practice Address - Fax:615-342-0213
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4011174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCQ33228Medicare ID - Type Unspecified