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NPI Code Detail

MEDICARE: MR. MARK L. ARCHAMBAULT PT, PHD

MEDICARE:  MR. MARK L. ARCHAMBAULT  PT, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPTL0016304CO

General Provider Information

NPI Number : 1174628333
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK L. ARCHAMBAULT PT, PHD
Provider Business Mailing Address
First Line : PO BOX 5718
Second Line :
City : KALISPELL
State : MT
Zip : 59903-5718
Country : US
Telephone Number : 406-756-0134
Fax Number : 406-309-2579
Provider Business Practice Location Address
First Line : 3854 VILLAGE SEVEN RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80917-2801
Country : US
Telephone Number : 719-574-8761
Fax Number : 719-574-8236
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 12/10/2019

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Directions to “ MR. MARK L. ARCHAMBAULT PT, PHD” Practice Location

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