Provider Demographics
NPI:1538485073
Name:EVERETT, MARYANNE (LMT)
Entity Type:Individual
Prefix:MRS
First Name:MARYANNE
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8744 STATE ROAD 21
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:FL
Mailing Address - Zip Code:32666-8809
Mailing Address - Country:US
Mailing Address - Phone:352-215-7335
Mailing Address - Fax:
Practice Address - Street 1:8744 STATE ROAD 21
Practice Address - Street 2:
Practice Address - City:MELROSE
Practice Address - State:FL
Practice Address - Zip Code:32666-8809
Practice Address - Country:US
Practice Address - Phone:352-215-7335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA30619172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist