Provider Demographics
NPI:1366401507
Name:BATY, MARK R (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:BATY
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 1:90 SPRINGVIEW LN STE B
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29485-8153
Mailing Address - Country:US
Mailing Address - Phone:843-875-2959
Mailing Address - Fax:843-875-2836
Practice Address - Street 1:90 SPRINGVIEW LN STE B
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-8153
Practice Address - Country:US
Practice Address - Phone:843-875-2959
Practice Address - Fax:843-875-2836
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC7994Medicare ID - Type Unspecified