Provider Demographics
NPI:1629579156
Name:HEWELT, MARY ALICE (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:HEWELT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Mailing Address - Street 1:PO BOX 412031
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2031
Mailing Address - Country:US
Mailing Address - Phone:914-294-4050
Mailing Address - Fax:631-760-8306
Practice Address - Street 1:8158 COOLEY LAKE RD
Practice Address - Street 2:
Practice Address - City:WHITE LAKE
Practice Address - State:MI
Practice Address - Zip Code:48386-4309
Practice Address - Country:US
Practice Address - Phone:248-956-1894
Practice Address - Fax:248-430-7066
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5501009499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist