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Individual
MR. MARK T BASTAN
Active
Individual
MR. MARK T BASTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT02008
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
27877
NEIGHBORHOOD HEALTH
RI
01
—
29806-7
BLUE CROSS
RI
01
—
413078
BLUE CHIP
RI
Enumeration date
08/31/2006
Last updated
07/08/2007
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