Provider Demographics
NPI:1538185608
Name:NIX, MARK KENNETH (DPT)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:KENNETH
Last Name:NIX
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 FOREST HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29702-8901
Mailing Address - Country:US
Mailing Address - Phone:864-839-5895
Mailing Address - Fax:
Practice Address - Street 1:118 FOREST HAVEN DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:SC
Practice Address - Zip Code:29702-8901
Practice Address - Country:US
Practice Address - Phone:864-839-5895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist