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Individual
MARK KERESTAN
Active
Individual
MARK KERESTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT006525L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015935850006
—
PA
01
—
251570641
TAX ID
PA
Enumeration date
06/30/2006
Last updated
02/11/2009
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