Individual
MARK WILLIAM HAVILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
416 N 6TH ST, DENTON, MD 21629-1356
(410) 822-4613
(410) 822-6534
Mailing address
817 LONG POINT RD, GRASONVILLE, MD 21638-1072
(410) 822-4613
(410) 822-6534
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
15706
MD
Other
Enumeration date
11/07/2006
Last updated
07/08/2007
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