Provider Demographics
NPI:1639520091
Name:SAPALARAN, MARY JO (PT)
Entity Type:Individual
Prefix:MISS
First Name:MARY JO
Middle Name:
Last Name:SAPALARAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 S EASTERN AVE
Mailing Address - Street 2:STE. 9
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-6118
Mailing Address - Country:US
Mailing Address - Phone:702-379-6983
Mailing Address - Fax:
Practice Address - Street 1:4510 S EASTERN AVE
Practice Address - Street 2:STE. 9
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6118
Practice Address - Country:US
Practice Address - Phone:702-379-6983
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3683225100000X
NY040225225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist