Provider Demographics
NPI:1437250263
Name:DEVOE, MARY KATHERINE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHERINE
Last Name:DEVOE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 CHARTER LN APT 407
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-0525
Mailing Address - Country:US
Mailing Address - Phone:910-520-4391
Mailing Address - Fax:
Practice Address - Street 1:201 2ND ST STE 1100
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-6328
Practice Address - Country:US
Practice Address - Phone:478-745-9200
Practice Address - Fax:478-745-9040
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC40212251P0200X
GAPT0137722251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC079M0OtherBCBS