Provider Demographics
NPI:1992258040
Name:BELL, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:BELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 W DIMOND BLVD STE 121
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-1515
Mailing Address - Country:US
Mailing Address - Phone:907-344-0033
Mailing Address - Fax:907-344-6332
Practice Address - Street 1:750 W DIMOND BLVD STE 121
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-1515
Practice Address - Country:US
Practice Address - Phone:907-344-0033
Practice Address - Fax:907-344-6332
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK101624225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist