Healthcare Provider Details

I. General information

NPI: 1881661841
Provider Name (Legal Business Name): MARK STUART DAASCH PT
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1198 SMILEY AVE
CINCINNATI OH
45240-1865
US

IV. Provider business mailing address

8085 THISTLEWOOD DR
WEST CHESTER OH
45069-2010
US

V. Phone/Fax

Practice location:
  • Phone: 513-671-6362
  • Fax: 513-671-6368
Mailing address:
  • Phone: 513-755-6023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number6986
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: