Provider Demographics
NPI:1467528240
Name:ENGROFF, MARY LYNN (PT, PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LYNN
Last Name:ENGROFF
Suffix:
Gender:F
Credentials:PT, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4774 S CLASSICAL BLVD
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33445-1225
Mailing Address - Country:US
Mailing Address - Phone:561-346-9162
Mailing Address - Fax:
Practice Address - Street 1:7595 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2532
Practice Address - Country:US
Practice Address - Phone:561-433-2564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL7384174400000X
FL9102324363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY5555OtherBCBS #
FL7384OtherPT PROVIDER #
FLY5555Medicare ID - Type UnspecifiedPHYSICAL THERAPY