MEDICARE: MARK NAVYAC 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
1	225100000X	Physical Therapist	PT017879	PA
2	225100000X	Physical Therapist	PT.009684	OH

General Provider Information

NPI Number	:	1720113830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK NAVYAC P.T.

Provider Business Mailing Address
First Line	:	47216 TOMAHAWK DR
Second Line	:
City	:	NEGLEY
State	:	OH
Zip	:	44441-9744
Country	:	US
Telephone Number	:	330-227-9208
Fax Number	:

Provider Business Practice Location Address
First Line	:	527 E LONG AVE
Second Line	:
City	:	NEW CASTLE
State	:	PA
Zip	:	16101-4843
Country	:	US
Telephone Number	:	724-654-4545
Fax Number	:

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

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	07/08/2007

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Directions to “ MARK NAVYAC P.T.” Practice Location

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