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General NPI Number Information
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NPI Number | 1457311631
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Entity Type | Individual
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Provider Name | MARK ALAN ANKENBRAND P.T.
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Gender | Male
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 07/19/2012
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Provider Practice Location Address
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Address Line | 1300 N. MARKET
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City | SPARTA
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State | IL
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Zip | 62286-1048
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Country | US
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Telephone | 618-443-2177
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Fax | 618-443-4731
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Provider Business Mailing Address
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Address Line | P.O. BOX 297 818 E. BROADWAY
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City | SPARTA
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State | IL
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Zip | 62286-0297
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Country | US
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Telephone | 618-443-2177
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Fax | 618-443-1383
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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 | 2005036024
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.005247
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License Number State | IL
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