Healthcare Provider Details

I. General information

NPI: 1851832638
Provider Name (Legal Business Name): MARK CLAYTON DE BINDER SR. BS, LMT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 WATERMAN ST
PROVIDENCE RI
02906-3116
US

IV. Provider business mailing address

97 FARNUM PIKE UNIT 7
SMITHFIELD RI
02917-3319
US

V. Phone/Fax

Practice location:
  • Phone: 401-965-9756
  • Fax:
Mailing address:
  • Phone: 401-965-9756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code173C00000X
TaxonomyReflexologist
License NumberMT02104
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License NumberMT02104
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: