Individual
MR. MARK WAIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
844 PASSOVER RD, OSAGE BEACH, MO 65065-2834
(573) 348-2225
(573) 348-5601
Mailing address
31375 CHATEAU DR, ROCKY MOUNT, MO 65072-2949
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
101404
MO
Other
Enumeration date
09/16/2006
Last updated
07/08/2007
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