Active NPI
Mark A. Hose, MPT
- Physical Therapist
- Blacksville, WV
National Provider Identifier
1649427949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT002047
- Practice address
- 5804 Mason Dixon Hwy
Blacksville, WV 26521-9998 - Phone
- (304) 879-5000
- Fax
- (304) 879-5007
- NPI assigned
- Aug 19, 2008
- Last updated
- Oct 25, 2013
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT002047 | WV | Primary |
Addresses
Primary practice location
5804 Mason Dixon Hwy
Blacksville, WV 26521-9998
Mailing address
943 Maple Dr
Morgantown, WV 26505-2812
Phone (304) 599-2515
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810012948 | Medicaid | WV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WV
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20080916000241 | WV | Practitioner - Physical Therapist in Private Practice | 7517034655 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT002047 | WV | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1382659200000",
"number": "1649427949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "943 MAPLE DR",
"city": "MORGANTOWN",
"state": "WV",
"postal_code": "265052812",
"telephone_number": "304-599-2515",
"fax_number": "304-285-3738"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5804 MASON DIXON HWY",
"city": "BLACKSVILLE",
"state": "WV",
"postal_code": "265219998",
"telephone_number": "304-879-5000",
"fax_number": "304-879-5007"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HOSE",
"first_name": "MARK",
"middle_name": "A.",
"credential": "MPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-19",
"last_updated": "2013-10-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "WV",
"license": "PT002047",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3810012948",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blacksville, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.