Provider Demographics
NPI:1235300971
Name:RAYMOND, MARY L (PT, MS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:L
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 NICKLAUS BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33903-5600
Mailing Address - Country:US
Mailing Address - Phone:708-227-3478
Mailing Address - Fax:
Practice Address - Street 1:129 NICKLAUS BLVD
Practice Address - Street 2:
Practice Address - City:NORTH FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33903-5600
Practice Address - Country:US
Practice Address - Phone:708-227-3478
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT37433225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist