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NPI Code Detail

MEDICARE: MR. MARK PERSON PTA

MEDICARE: MR. MARK PERSON PTA
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
1314000000XSkilled Nursing Facility5022TN
2314000000XSkilled Nursing Facility5022TX

General Provider Information

NPI Number : 1427321652
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARK PERSON PTA
Provider Business Mailing Address
First Line : 90 DUNCAN DR
Second Line :
City : JACKSON
State : TN
Zip : 38305-1509
Country : US
Telephone Number : 731-298-1848
Fax Number :
Provider Business Practice Location Address
First Line : 5515 GLEN LAKES DR
Second Line :
City : DALLAS
State : TX
Zip : 75231-4309
Country : US
Telephone Number : 214-361-8923
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2012
Last Update Date : 02/19/2012

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