Provider Demographics
NPI:1245418367
Name:PLUMMER, MARYBETH (PT)
Entity Type:Individual
Prefix:MS
First Name:MARYBETH
Middle Name:
Last Name:PLUMMER
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 1:2403 SAN MATEO BLVD NE
Mailing Address - Street 2:W-24
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4058
Mailing Address - Country:US
Mailing Address - Phone:505-268-6278
Mailing Address - Fax:505-266-0799
Practice Address - Street 1:2403 SAN MATEO BLVD NE
Practice Address - Street 2:W-24
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4058
Practice Address - Country:US
Practice Address - Phone:505-268-6278
Practice Address - Fax:505-266-0799
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-31
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM743261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy