Provider Demographics
NPI:1639367691
Name:BILLS, MARY J (PTA)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:BILLS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WHIPPLE LANE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622
Mailing Address - Country:US
Mailing Address - Phone:585-338-3070
Mailing Address - Fax:585-336-5014
Practice Address - Street 1:1 WHIPPLE LN
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2528
Practice Address - Country:US
Practice Address - Phone:585-338-3070
Practice Address - Fax:585-336-5014
Is Sole Proprietor?:No
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006375-1225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant