Individual
MR. MARK ALLEN SUNDERMAN
Active
Individual
MR. MARK ALLEN SUNDERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT, GCS
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
659
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2223
GERIATRIC SPECIALIST LICE
NE
01
—
48110
NATIONAL LISCENSE
NE
Enumeration date
03/28/2007
Last updated
07/08/2007
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