Documento, Mark

Documento, Mark is an individual health care provider with primary practice located at 266 Nw Peacock Blvd Suite 2-204 Bldg. 2, Port Saint Lucie FL 34986-2271. He recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist, which is considered as his primary health care specialty. Documento, Mark can be contacted via phone (772) 408-6630.

Contact Information

Primary practice address
266 Nw Peacock Blvd Suite 2-204 Bldg. 2 Port Saint Lucie FL 34986-2271
Phone: (772) 408-6630
Fax: (772) 408-6750
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT20821 Florida

Profile Details

NPI number 1316104292
LBN Legal business name Documento, Mark
Credentials Registered Physical Therapist (RPT)
Entity Individual
Sole proprietor 1 No
Enumeration date May 19th, 2008
Last updated Apr 9th, 2009 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1316104292 NPPES
Florida Other BK828Z PROVIDER TRANSACTION ACCESS NUMBER

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