Individual
MR. MARK ELLIOT WURSTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.S.P.T.
Contact information
Practice address
872 SMITHFIELD AVE, LINCOLN, RI 02865-3500
(401) 722-0012
(401) 722-0056
Mailing address
100 HIGHLAND AVE, STE 305, PROVIDENCE, RI 02906-2753
(401) 722-0012
(401) 722-0056
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
7136
MA
225100000X
Physical Therapist
822
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000Y66669
BLUE CROSS OF MA
MA
01
—
050504796
UNITED HEALTHCARE
RI
01
—
402345
BLUE CHIP
RI
01
—
7857-1
BLUE CROSS
RI
Enumeration date
09/28/2006
Last updated
06/21/2018
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