MEDICARE: MR. PAUL E MARKS 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	11 02584	KS

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00117292	OTHER	KS	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	954896578	OTHER	KS	TAX ID
2	115594	OTHER	KS	BC/BS OF KS GROUP #
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	140485	OTHER	KS	BC/ BS OF KS #

General Provider Information

NPI Number	:	1740284629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL E MARKS PT

Provider Business Mailing Address
First Line	:	2311 WAKARUSA DR
Second Line	:	STE E
City	:	LAWRENCE
State	:	KS
Zip	:	66047-3350
Country	:	US
Telephone Number	:	785-856-9966
Fax Number	:	785-856-9967

Provider Business Practice Location Address
First Line	:	2311 WAKARUSA DR
Second Line	:	STE E
City	:	LAWRENCE
State	:	KS
Zip	:	66047-3350
Country	:	US
Telephone Number	:	785-856-9966
Fax Number	:	785-856-9967

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/07/2014

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Directions to “ MR. PAUL E MARKS PT” Practice Location

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