Provider Demographics
NPI:1932350444
Name:NIMCHUK, MARK (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:NIMCHUK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:133 W HUNTING PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19140-2717
Mailing Address - Country:US
Mailing Address - Phone:215-455-5370
Mailing Address - Fax:215-455-5374
Practice Address - Street 1:3251 CEDAR ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-4514
Practice Address - Country:US
Practice Address - Phone:215-427-2242
Practice Address - Fax:215-427-2433
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT010940L2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics