Provider Demographics
NPI:1427641299
Name:MARK, GRACE (DPT)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:MARK
Suffix:
Gender:
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4 RICHMOND SQ STE 200
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5117
Mailing Address - Country:US
Mailing Address - Phone:401-433-4172
Mailing Address - Fax:401-433-0612
Practice Address - Street 1:501 JOHN MAHAR HWY STE 200
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-6563
Practice Address - Country:US
Practice Address - Phone:781-384-0500
Practice Address - Fax:781-848-0501
Is Sole Proprietor?:No
Enumeration Date:2021-02-12
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA25109OtherPT LICENSE