Individual
MR. MARK STEVEN PURCELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
1118 14TH AVE, LONGVIEW, WA 98632-3017
(360) 636-4360
(360) 425-5250
Mailing address
1118 14TH AVE, LONGVIEW, WA 98632-3017
(360) 636-4360
(360) 425-5250
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT00002437
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0103-981
DEPARTMENT OF L & I NO.
WA
01
—
182420
OMAP PROVIDER NUMBER
WA
01
—
6500 24408
RAILROAD MEDICARE NUMBER
WA
05
—
8413445
—
WA
01
—
PU0807
REGENCE PROVIDER NUMBER
WA
Enumeration date
01/13/2006
Last updated
07/30/2010
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