MEDICARE: MARK J PIERCE

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
1	261QP2000X	Physical Therapy Clinic/Center	602471099	WA

General Provider Information

NPI Number	:	1407253867
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARK J PIERCE

Provider Business Mailing Address
First Line	:	13120 NE 70TH PL
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-8570
Country	:	US
Telephone Number	:	425-889-0776
Fax Number	:	425-889-0857

Provider Business Practice Location Address
First Line	:	13120 NE 70TH PL
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-8570
Country	:	US
Telephone Number	:	425-889-0776
Fax Number	:	425-889-0857

Authorized Official
Title or Position	:	OWNER
Name	:	MARK JAMES PIERCE
Credential	:	LPTA
Telephone Number	:	425-889-0776

Provider Enumeration Date	:	12/01/2014
Last Update Date	:	12/01/2014

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