| Doctor Name: | MR. MARK DOCUMENTO |
| NPI Number: | 1316104292 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RPT |
| License Number: | PT20821 |
| Business Practice Address: | 266 Nw Peacock Blvd Suite 2-204 Bldg. 2 Port Saint Lucie, FL - 349862271 |
| Business Phone Number: | 7724086630 |
| Business Fax Number: | 7724086750 |
| Mailing Address: | Po Box 7666, PORT SAINT LUCIE |
| State: | FL |
| Postal Code: | 349857666 |
| Phone Number: | 7724086630 |
| Fax Number: | 7724086750 |
| NPI Enumeration Date: | 05/19/2008 |
| NPI Last Update Date: | 04/09/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 225100000X |
| License Number: | PT20821 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Taxonomy Classification: | Physical Therapist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) Physical therapists are health care professionals who evaluate and treat people with health problems resulting from injury or disease. PT |