Provider Demographics
NPI:1003865528
Name:TOEPFER, MARY JANE (LMT)
Entity Type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:TOEPFER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 HOLLINGHAM RISE
Mailing Address - Street 2:
Mailing Address - City:FAIRPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14450-1601
Mailing Address - Country:US
Mailing Address - Phone:585-425-0920
Mailing Address - Fax:585-425-0920
Practice Address - Street 1:6605 PITTSFORD PALMYRA RD
Practice Address - Street 2:SUITE E-9
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-3407
Practice Address - Country:US
Practice Address - Phone:585-223-0644
Practice Address - Fax:585-223-1582
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011013225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY175937GGOtherPREFERRED CARE