Individual
MR. MARK T BASTAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
535 CENTERVILLE RD, SUITE 101, WARWICK, RI 02886-4376
(401) 737-4581
(401) 737-6152
Mailing address
535 CENTERVILLE RD, SUITE 101, WARWICK, RI 02886-4376
(401) 737-4581
(401) 737-6152
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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