Provider Demographics
NPI:1285855395
Name:MARY NATES SOUZA
Entity Type:Organization
Organization Name:MARY NATES SOUZA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:MONICA
Authorized Official - Last Name:NATES SOUZA
Authorized Official - Suffix:
Authorized Official - Credentials:RPT
Authorized Official - Phone:508-669-6810
Mailing Address - Street 1:360 COUNTRY HILL DRIVE
Mailing Address - Street 2:
Mailing Address - City:NORTH DIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02764
Mailing Address - Country:US
Mailing Address - Phone:508-669-6810
Mailing Address - Fax:
Practice Address - Street 1:360 COUNTRY HILL DRIVE
Practice Address - Street 2:
Practice Address - City:NORTH DIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02764
Practice Address - Country:US
Practice Address - Phone:508-669-6810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA5118313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility