Mark Sevan Bourque JR., PTA

NPI #1033685664 in Mobile, Alabama

Provider Information

NPI Number: 1033685664
Entity Type: Individual
Name: Mark Sevan Bourque JR., PTA
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Physical Therapy Assistant
Credential: PTA
Enumeration Date: Oct 22, 2018
Last Updated: Oct 22, 2018

Practice Location

Address: 1220 AZALEA RD
City: Mobile
State: Alabama
ZIP Code: 36693-2859
Phone: (125) 158-3165

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Physical Therapy Assistant	225200000X	Primary

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