Provider Demographics
NPI:1437238896
Name:ATER, MARY ANNE (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANNE
Last Name:ATER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ANNE
Other - Last Name:YOCHUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:2865 S MOUNT ZION CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:PEKIN
Mailing Address - State:IN
Mailing Address - Zip Code:47165-8111
Mailing Address - Country:US
Mailing Address - Phone:812-704-2806
Mailing Address - Fax:888-357-6040
Practice Address - Street 1:2525 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-2556
Practice Address - Country:US
Practice Address - Phone:812-542-3651
Practice Address - Fax:888-357-6040
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-04
Last Update Date:2020-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05003245A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200660710OtherFIRST STEPS PROVIDER #
IN05003245AOtherINDIANA PT LICENSE
IN200731960OtherEMPLOYER FIRST STEP #