Provider Demographics
NPI:1407107204
Name:TENORIO, MARY MICHELLE L (PT)
Entity Type:Individual
Prefix:
First Name:MARY MICHELLE
Middle Name:L
Last Name:TENORIO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY MICHELLE
Other - Middle Name:
Other - Last Name:LOQUIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 FEDERAL ST # 200
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08103-1088
Mailing Address - Country:US
Mailing Address - Phone:856-356-4924
Mailing Address - Fax:
Practice Address - Street 1:2339 ROUTE 70 W FL 4
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-3315
Practice Address - Country:US
Practice Address - Phone:856-751-6464
Practice Address - Fax:856-536-1417
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5275225100000X
NJ40QA02019500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist