Provider Demographics
NPI:1558584706
Name:WORRELL, MARY REGINA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:REGINA
Last Name:WORRELL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38360 HOLLY HILL DR
Mailing Address - Street 2:
Mailing Address - City:BAY MINETTE
Mailing Address - State:AL
Mailing Address - Zip Code:36507-8356
Mailing Address - Country:US
Mailing Address - Phone:251-232-0213
Mailing Address - Fax:
Practice Address - Street 1:1512 S US HIGHWAY 31
Practice Address - Street 2:
Practice Address - City:BAY MINETTE
Practice Address - State:AL
Practice Address - Zip Code:36507-2611
Practice Address - Country:US
Practice Address - Phone:251-580-3232
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4214225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist