Provider Demographics
NPI:1174658140
Name:GENDAY, MARY BETH (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:GENDAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2173 BODINE PL
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9372
Mailing Address - Country:US
Mailing Address - Phone:317-885-1264
Mailing Address - Fax:
Practice Address - Street 1:637 S STATE ROAD 135
Practice Address - Street 2:STE C
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1443
Practice Address - Country:US
Practice Address - Phone:317-865-1110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05008683A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist