Individual
MARK THELEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6780
Mailing address
1061 HARMON AVE STE 1D03, FORT STEWART, GA 31314-5641
(912) 435-6780
Taxonomy
Speciality
Code
Description
License number
State
2251X0800X
Orthopedic Physical Therapist
Primary
4300
SC
Other
Enumeration date
08/17/2005
Last updated
01/28/2011
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