Provider Demographics
NPI:1437540804
Name:TOLLESON, MARY (MSPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:TOLLESON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:TOLLESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSPT
Mailing Address - Street 1:2001 N MCNEELY RD
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:AR
Mailing Address - Zip Code:72364-9606
Mailing Address - Country:US
Mailing Address - Phone:870-733-2323
Mailing Address - Fax:
Practice Address - Street 1:2001 N MCNEELY RD
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:AR
Practice Address - Zip Code:72364-9606
Practice Address - Country:US
Practice Address - Phone:870-733-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT1345225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist