Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | J10000814 | DE |
N | 2251G0304X | Physical Therapist - Geriatrics | J10000814 | DE |
Y | 2251H1200X | Hand | J10000814 | DE |
N | 2251S0007X | Physical Therapist - Sports | J10000814 | DE |
N | 2251X0800X | Physical Therapist - Orthopedic | J10000814 | DE |
NPI | 1932163672 |
---|---|
Provider Name | Ms. Mary Mundrane |
First Address | Dover, DE 19904-7793 |
Second Address | Dover, DE 19904-7793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2006 |
Last Update Date | 01/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0717329000 | AMERIHEALTH (01) | DE |
P00294512 | MEDICARE RAILROAD (01) | DE |
P89776 | (02) | DE |