Healthcare Provider Details

I. General information

NPI: 1336694884
Provider Name (Legal Business Name): MARK CIOLEK PT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2016
Last Update Date: 09/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 S CAMPUS AVE
OXFORD OH
45056-2487
US

IV. Provider business mailing address

PO BOX 636962
CINCINNATI OH
45263-6962
US

V. Phone/Fax

Practice location:
  • Phone: 513-529-3000
  • Fax: 513-529-1892
Mailing address:
  • Phone: 513-569-6117
  • Fax: 513-853-4740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number16320
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: