Provider Demographics
NPI:1629021464
Name:DEPUTRON, MARYANNE (MSPT)
Entity Type:Individual
Prefix:
First Name:MARYANNE
Middle Name:
Last Name:DEPUTRON
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1265 WAYNE AVENUE, SUITE 308
Mailing Address - Street 2:119 PROFESSIONAL BUILDING
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-3508
Mailing Address - Country:US
Mailing Address - Phone:724-801-8095
Mailing Address - Fax:724-801-8147
Practice Address - Street 1:1651-53 PULASKI HIGHWAY
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-1453
Practice Address - Country:US
Practice Address - Phone:302-834-1550
Practice Address - Fax:302-834-1549
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0001053225100000X
PAPT009263L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE20029500000OtherAMERIHEALTH
PA836024OtherBCBS
PA146334VLZOtherMEDICARE
P00692858OtherRAILROAD MEDICARE
DE1629021464Medicaid
MD3556042Medicaid
DEAC44-0021OtherCAREFIRST
DE836024OtherHIGHMARK
DE1629021464Medicaid
5482101OtherAETNA
000051056OtherDPCI
PA102314739Medicaid
PA102314739-0001Medicaid
DE1629021464Medicaid