Mack, Ken

Mack, Ken is an individual health care provider with primary practice located at 1005 N Hickory Rd , South Bend IN 46615-3723. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Mack, Ken can be contacted via phone (574) 233-5754.

Contact Information

Primary practice address
1005 N Hickory Rd South Bend IN 46615-3723
Phone: (574) 233-5754
Fax: (574) 233-7406
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X 06003673 Indiana

Profile Details

NPI number 1083926158
LBN Legal business name Mack, Ken
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 6th, 2010
Last updated Jul 6th, 2010 - about 15 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 1083926158 NPPES
Indiana MEDICAID 100351040

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