Individual
MR. MARK D CHANACA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
2200 CROW LN, MYRTLE BEACH, SC 29577-1663
(843) 848-5000
Mailing address
PO BOX 421718, GEORGETOWN, SC 29442-4203
(843) 652-8226
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
4652
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
TH1418
—
SC
Enumeration date
05/12/2006
Last updated
03/10/2021
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