Provider Demographics
NPI:1114104841
Name:MURPHY, MARY JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JO
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4067 LAKE ELEANOR DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-5204
Mailing Address - Country:US
Mailing Address - Phone:352-326-8115
Mailing Address - Fax:352-326-5282
Practice Address - Street 1:4067 LAKE ELEANOR DR
Practice Address - Street 2:
Practice Address - City:MOUNT DORA
Practice Address - State:FL
Practice Address - Zip Code:32757-5204
Practice Address - Country:US
Practice Address - Phone:352-326-8115
Practice Address - Fax:352-326-5282
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT21740225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDG328ZMedicare Oscar/Certification