Provider Demographics
NPI:1265404370
Name:RINCON, MARK ANTHONY (PT)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:RINCON
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 1:9718 SUNNYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96062-9514
Mailing Address - Country:US
Mailing Address - Phone:530-547-3113
Mailing Address - Fax:
Practice Address - Street 1:1024 MISTLETOE LN
Practice Address - Street 2:SUITE A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0721
Practice Address - Country:US
Practice Address - Phone:530-547-3113
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7301225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
00PT73012Medicare ID - Type Unspecified