Stack, Mark A

Stack, Mark A is an individual health care provider with primary practice located at 1043 Makawao Ave Suite 107, Makawao HI 96768-9465. 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. Stack, Mark A can be contacted via phone (808) 572-7790.

Contact Information

Primary practice address
1043 Makawao Ave Suite 107 Makawao HI 96768-9465
Phone: (808) 572-7790
Fax: (808) 573-4721
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapist 225100000X PT-1242 Hawaii

Profile Details

NPI number 1962467746
LBN Legal business name Stack, Mark A
Credentials Physical Therapist (PT)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 17th, 2006
Last updated Jul 8th, 2007 - about 17 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 1962467746 NPPES
Hawaii Other 1866663 UHA
Hawaii MEDICAID 24461708 UHA
Hawaii MEDICAID 24461709 UHA
Hawaii Other 194058 UHA

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