Provider Demographics
NPI:1609026103
Name:MARY E. LUNDY PT INC
Entity Type:Organization
Organization Name:MARY E. LUNDY PT INC
Other - Org Name:PROGRESSIVE PHYSICAL THERAPY OF DEVILS LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LUNDY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:701-662-5874
Mailing Address - Street 1:204 COLLEGE DR N
Mailing Address - Street 2:
Mailing Address - City:DEVILS LAKE
Mailing Address - State:ND
Mailing Address - Zip Code:58301-2925
Mailing Address - Country:US
Mailing Address - Phone:701-662-5874
Mailing Address - Fax:701-662-4552
Practice Address - Street 1:204 COLLEGE DR N
Practice Address - Street 2:
Practice Address - City:DEVILS LAKE
Practice Address - State:ND
Practice Address - Zip Code:58301-2925
Practice Address - Country:US
Practice Address - Phone:701-662-5874
Practice Address - Fax:701-662-4552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty