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NPI Code Detail

MEDICARE: MARK ALAN ANKENBRAND P.T.

MEDICARE: MARK ALAN ANKENBRAND P.T.
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 Therapist2005036024MO
2225100000XPhysical Therapist070.005247IL

General Provider Information

NPI Number : 1457311631
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ALAN ANKENBRAND P.T.
Provider Business Mailing Address
First Line : P.O. BOX 297
Second Line : 818 E. BROADWAY
City : SPARTA
State : IL
Zip : 62286-0297
Country : US
Telephone Number : 618-443-2177
Fax Number : 618-443-1383
Provider Business Practice Location Address
First Line : 1300 N. MARKET
Second Line :
City : SPARTA
State : IL
Zip : 62286-1048
Country : US
Telephone Number : 618-443-2177
Fax Number : 618-443-4731
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2006
Last Update Date : 07/19/2012

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Directions to “ MARK ALAN ANKENBRAND P.T.” Practice Location

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