Provider Demographics
NPI:1427025246
Name:BIANCO, MARY JANE (MSPT)
Entity Type:Individual
Prefix:MRS
First Name:MARY JANE
Middle Name:
Last Name:BIANCO
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13654 JONQUIL PL
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8558
Mailing Address - Country:US
Mailing Address - Phone:561-784-2434
Mailing Address - Fax:
Practice Address - Street 1:2670 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5972
Practice Address - Country:US
Practice Address - Phone:561-968-9100
Practice Address - Fax:561-968-9233
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20812225100000X
NJ40QA00593500225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist