Provider Demographics
NPI:1528207958
Name:NAKFOOR, MARY MARCELLA (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARCELLA
Last Name:NAKFOOR
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:804 SERVICE ROAD
Mailing Address - Street 2:ROOM A202C
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48824-1315
Mailing Address - Country:US
Mailing Address - Phone:517-355-3053
Mailing Address - Fax:
Practice Address - Street 1:804 SERVICE ROAD
Practice Address - Street 2:ROOM A114
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48824-7038
Practice Address - Country:US
Practice Address - Phone:517-355-7648
Practice Address - Fax:517-432-1319
Is Sole Proprietor?:No
Enumeration Date:2009-02-09
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501000907225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist