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General NPI Number Information
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NPI Number | 1033619846
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Entity Type | Organization
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Legal Business Name | ST MARK VILLAGE INC
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Dates
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Enumeration Date | 02/19/2018
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Last Update Date | 02/19/2018
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Provider Practice Location Address
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Address Line | 2655 NEBRASKA AVE
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City | PALM HARBOR
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State | FL
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Zip | 34684-2630
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Country | US
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Telephone | 727-785-2577
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Fax | 727-464-1785
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Provider Business Mailing Address
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Address Line | 2655 NEBRASKA AVE
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City | PALM HARBOR
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State | FL
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Zip | 34684-2630
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Country | US
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Telephone | 727-785-2577
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Fax | 727-464-1785
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | CYNTHIA POHL
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Credential | MBA
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Telephone | 727-785-2577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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