Provider Demographics
NPI:1194895128
Name:MARK, SHEILA R (PT)
Entity type:Individual
Prefix:MRS
First Name:SHEILA
Middle Name:R
Last Name:MARK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2334
Mailing Address - Country:US
Mailing Address - Phone:740-593-8787
Mailing Address - Fax:740-592-5989
Practice Address - Street 1:603 W UNION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2334
Practice Address - Country:US
Practice Address - Phone:740-593-8787
Practice Address - Fax:740-592-5989
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1197225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1197OtherPHYSICAL THERAPY LICENSE NUMBER