Provider Demographics
NPI:1518028547
Name:HERMES, MARY E (MSPT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:HERMES
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7629 GIRARD AVE
Mailing Address - Street 2:201
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0076
Mailing Address - Country:US
Mailing Address - Phone:773-495-6522
Mailing Address - Fax:858-255-8364
Practice Address - Street 1:7629 GIRARD AVE
Practice Address - Street 2:201
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0076
Practice Address - Country:US
Practice Address - Phone:773-495-6522
Practice Address - Fax:858-255-8364
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-011690225100000X
CA24707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL20-5186080OtherFEIN