Provider Demographics
NPI:1366831497
Name:RICH, MARK R (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:RICH
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:60 SHUFORD RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-7406
Mailing Address - Country:US
Mailing Address - Phone:828-894-0277
Mailing Address - Fax:828-894-0278
Practice Address - Street 1:4687 BOYLSTON HWY
Practice Address - Street 2:
Practice Address - City:MILLS RIVER
Practice Address - State:NC
Practice Address - Zip Code:28759-6731
Practice Address - Country:US
Practice Address - Phone:828-890-0040
Practice Address - Fax:828-890-0530
Is Sole Proprietor?:No
Enumeration Date:2015-01-13
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCP2769225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist