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General NPI Number Information
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NPI Number | 1518142215
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Entity Type | Individual
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Provider Name | MARK ROOT CFO COF
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Gender | Male
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Dates
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Enumeration Date | 01/01/2008
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Last Update Date | 01/01/2008
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Provider Practice Location Address
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Address Line | 5950 HAMPTON LEAS LN
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City | COLUMBIA
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State | SC
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Zip | 29209-1900
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Country | US
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Telephone | 803-960-0952
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Fax | 803-776-6639
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Provider Business Mailing Address
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Address Line | 5950 HAMPTON LEAS LN
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City | COLUMBIA
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State | SC
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Zip | 29209-1900
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Country | US
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Telephone | 803-960-0952
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Fax | 803-776-6639
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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 | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number |
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License Number State |
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