Provider Demographics
NPI:1063589919
Name:VANLOAN, MARK C (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:VANLOAN
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 1:1920 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-1943
Mailing Address - Country:US
Mailing Address - Phone:530-243-1102
Mailing Address - Fax:530-243-1123
Practice Address - Street 1:1920 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-1943
Practice Address - Country:US
Practice Address - Phone:530-243-1102
Practice Address - Fax:530-243-1123
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26561225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist