Provider Demographics
NPI:1306918701
Name:MOONEY, MARK D (PT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:D
Last Name:MOONEY
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Gender:M
Credentials:PT
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Mailing Address - Street 1:1440 S CLEARVIEW AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85209-3381
Mailing Address - Country:US
Mailing Address - Phone:480-854-9833
Mailing Address - Fax:480-854-9834
Practice Address - Street 1:1440 S CLEARVIEW AVE
Practice Address - Street 2:STE 104
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85209-3381
Practice Address - Country:US
Practice Address - Phone:480-832-9308
Practice Address - Fax:480-807-1782
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2016-03-18
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Provider Licenses
StateLicense IDTaxonomies
AZ2346225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ65128Medicare ID - Type UnspecifiedMEDICARE