Provider Demographics
NPI:1619098191
Name:NIEDENTHAL, MARY ALICE (MA, PT, PCS)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALICE
Last Name:NIEDENTHAL
Suffix:
Gender:F
Credentials:MA, PT, PCS
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Other - Middle Name:
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Mailing Address - Street 1:768 GREENTREE RD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47025-7674
Mailing Address - Country:US
Mailing Address - Phone:513-379-2898
Mailing Address - Fax:812-539-4570
Practice Address - Street 1:768 GREENTREE RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEBURG
Practice Address - State:IN
Practice Address - Zip Code:47025-7674
Practice Address - Country:US
Practice Address - Phone:513-379-2898
Practice Address - Fax:812-539-4570
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN05006847A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist