Provider Demographics
NPI:1053660845
Name:DRIGGERS, MARA JEANINE (DPT)
Entity Type:Individual
Prefix:DR
First Name:MARA
Middle Name:JEANINE
Last Name:DRIGGERS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31326 FOUNDERS AVE
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3728
Mailing Address - Country:US
Mailing Address - Phone:410-952-3114
Mailing Address - Fax:
Practice Address - Street 1:232 MITCHELL ST
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-9412
Practice Address - Country:US
Practice Address - Phone:302-934-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-07
Last Update Date:2016-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24157225100000X
SC6447225100000X
DEJ1-0002902225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist