Provider Demographics
NPI:1063544179
Name:HUNTINGTON, MARK WARREN (ATC, PT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:WARREN
Last Name:HUNTINGTON
Suffix:
Gender:M
Credentials:ATC, PT
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Mailing Address - Street 1:903 STATE ROAD 114 E
Mailing Address - Street 2:
Mailing Address - City:NORTH MANCHESTER
Mailing Address - State:IN
Mailing Address - Zip Code:46962-9382
Mailing Address - Country:US
Mailing Address - Phone:260-982-7819
Mailing Address - Fax:
Practice Address - Street 1:604 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:NORTH MANCHESTER
Practice Address - State:IN
Practice Address - Zip Code:46962-1276
Practice Address - Country:US
Practice Address - Phone:260-982-5033
Practice Address - Fax:260-982-5032
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1268225100000X
IN36000081A2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist