Provider Demographics
NPI:1720113830
Name:NAVYAC, MARK (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:NAVYAC
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47216 TOMAHAWK DR
Mailing Address - Street 2:
Mailing Address - City:NEGLEY
Mailing Address - State:OH
Mailing Address - Zip Code:44441-9744
Mailing Address - Country:US
Mailing Address - Phone:330-227-9208
Mailing Address - Fax:
Practice Address - Street 1:527 E LONG AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101-4843
Practice Address - Country:US
Practice Address - Phone:724-654-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT017879225100000X
OHPT.009684225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist