Provider Demographics
NPI:1275687782
Name:NAHMENS, MARY ANN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:NAHMENS
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 1:1670 S AMPHLETT BLVD
Mailing Address - Street 2:SUITE123
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2510
Mailing Address - Country:US
Mailing Address - Phone:650-558-0247
Mailing Address - Fax:650-558-1735
Practice Address - Street 1:1670 S AMPHLETT BLVD
Practice Address - Street 2:SUITE123
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2510
Practice Address - Country:US
Practice Address - Phone:650-558-0247
Practice Address - Fax:650-558-1735
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT9671225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19798ZMedicare ID - Type Unspecified