Provider Demographics
NPI:1285662247
Name:ORELLANO, MARY JANE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JANE
Last Name:ORELLANO
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 1:4301 W MARKHAM ST
Mailing Address - Street 2:SLOT # 547-11
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-7101
Mailing Address - Country:US
Mailing Address - Phone:501-296-1170
Mailing Address - Fax:501-296-1216
Practice Address - Street 1:4301 W MARKHAM ST
Practice Address - Street 2:SLOT # 547-11
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-7101
Practice Address - Country:US
Practice Address - Phone:501-296-1170
Practice Address - Fax:501-296-1216
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT628225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist