Provider Demographics
NPI:1629740105
Name:GUENTHER, MARY (PHYSICAL THERAPY)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:GUENTHER
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:665 GAINES SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3127
Mailing Address - Country:US
Mailing Address - Phone:706-369-8115
Mailing Address - Fax:
Practice Address - Street 1:665 GAINES SCHOOL RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3127
Practice Address - Country:US
Practice Address - Phone:706-369-8115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-02
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA004530225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
PTA004530OtherPTA LICENSEE