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Individual
MR. MARK DOCUMENTO
Active
Individual
MR. MARK DOCUMENTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT20821
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
BK828Z
PROVIDER TRANSACTION ACCESS NUMBER
FL
Enumeration date
05/19/2008
Last updated
04/09/2009
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