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General NPI Number Information
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NPI Number | 1073626610
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Entity Type | Individual
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Provider Name | MARK DOUGLAS MCENTIRE PT
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Gender | Male
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6499 MASON-MONTGOMERY ROAD SUITE D
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City | MASON
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State | OH
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Zip | 45040
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Country | US
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Telephone | 513-336-7642
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Fax |
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Provider Business Mailing Address
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Address Line | 8182 AUTUMN PLACE
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City | MASON
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State | OH
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Zip | 45040
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Country | US
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Telephone | 513-754-0390
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | 006893
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License Number State | OH
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