MEDICARE: MR. MARK GEORGE KASPROVIC 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	010963	OH

General Provider Information

NPI Number	:	1780892919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK GEORGE KASPROVIC P.T.

Provider Business Mailing Address
First Line	:	413 E JEFFREY PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1824
Country	:	US
Telephone Number	:	614-447-9426
Fax Number	:	614-352-2454

Provider Business Practice Location Address
First Line	:	413 E JEFFREY PL
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1824
Country	:	US
Telephone Number	:	614-447-9426
Fax Number	:	614-352-2454

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

Provider Enumeration Date	:	05/20/2007
Last Update Date	:	07/08/2007

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