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General NPI Number Information
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NPI Number | 1063544179
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Entity Type | Individual
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Provider Name | MARK WARREN HUNTINGTON ATC, PT
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Gender | Male
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Dates
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Enumeration Date | 03/12/2007
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 604 E COLLEGE AVE
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City | NORTH MANCHESTER
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State | IN
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Zip | 46962-1276
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Country | US
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Telephone | 260-982-5033
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Fax | 260-982-5032
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Provider Business Mailing Address
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Address Line | 903 STATE ROAD 114 E
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City | NORTH MANCHESTER
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State | IN
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Zip | 46962-9382
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Country | US
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Telephone | 260-982-7819
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 1268
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 36000081A
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License Number State | IN
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