MEDICARE: MR. MARK FRANKLIN STAPLES PT

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	225100000X	Physical Therapist	PTH 1013	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	510-77002	OTHER	AL	BCBS

General Provider Information

NPI Number	:	1669479754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK FRANKLIN STAPLES PT

Provider Business Mailing Address
First Line	:	1594 BERI BARFIELD DR
Second Line	:
City	:	DADEVILLE
State	:	AL
Zip	:	36853-4808
Country	:	US
Telephone Number	:	256-285-7456
Fax Number	:

Provider Business Practice Location Address
First Line	:	1120 AIRPORT DR
Second Line	:	STE 103
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-3444
Country	:	US
Telephone Number	:	256-329-8180
Fax Number	:	256-329-8116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	04/22/2008

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Directions to “ MR. MARK FRANKLIN STAPLES PT” Practice Location

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