Provider Demographics
NPI:1376718692
Name:GUELL, MARY F (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:F
Last Name:GUELL
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 1:225 MEMORIAL DRIVE
Mailing Address - Street 2:REHAB DEPARTMENT
Mailing Address - City:BERLIN
Mailing Address - State:WI
Mailing Address - Zip Code:54923
Mailing Address - Country:US
Mailing Address - Phone:920-361-5534
Mailing Address - Fax:
Practice Address - Street 1:225 MEMORIAL DRIVE
Practice Address - Street 2:REHAB DEPARTMENT
Practice Address - City:BERLIN
Practice Address - State:WI
Practice Address - Zip Code:54923
Practice Address - Country:US
Practice Address - Phone:920-361-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1506-024225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40030700Medicaid