Provider Demographics
NPI:1073751566
Name:BENGOA, MARY CATHERINE (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:CATHERINE
Last Name:BENGOA
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:535 S. HUMBOLDT ST
Mailing Address - Street 2:
Mailing Address - City:BATTLE MOUNTAIN
Mailing Address - State:NV
Mailing Address - Zip Code:89820
Mailing Address - Country:US
Mailing Address - Phone:775-635-3355
Mailing Address - Fax:775-635-3245
Practice Address - Street 1:535 S. HUMBOLDT ST
Practice Address - Street 2:
Practice Address - City:BATTLE MOUNTAIN
Practice Address - State:NV
Practice Address - Zip Code:89820
Practice Address - Country:US
Practice Address - Phone:775-635-3355
Practice Address - Fax:775-635-3245
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2009-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1626225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist