Active NPI
Mark Bourassa, PTA
- Physical Therapy Assistant
- Saginaw, MI
National Provider Identifier
1982097689
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 5502003302
- Practice address
- 1500 Weiss St
Saginaw, MI 48602-5251 - Phone
- (989) 497-2500
- Fax
- (989) 321-4948
- NPI assigned
- Mar 5, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 Therapy Assistant | 225200000X | 5502003302 | MI | Primary |
Addresses
Primary practice location
1500 Weiss St
Saginaw, MI 48602-5251
Mailing address
1220 E Reid Rd
Grand Blanc, MI 48439-8835
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5502003302 | MI | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1425513600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1425600000000",
"number": "1982097689",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1220 E REID RD",
"city": "GRAND BLANC",
"state": "MI",
"postal_code": "484398835"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 WEISS ST",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486025251",
"telephone_number": "989-497-2500",
"fax_number": "989-321-4948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURASSA",
"first_name": "MARK",
"credential": "PTA",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-03-05",
"last_updated": "2015-03-06",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "MI",
"license": "5502003302",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.