Provider Demographics
NPI:1639728967
Name:PRICKETT, MARYBETH
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:PRICKETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:ELIZABETH
Other - Last Name:PRICKETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1429 COLLINS AVE
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-5305
Mailing Address - Country:US
Mailing Address - Phone:412-527-7165
Mailing Address - Fax:
Practice Address - Street 1:1429 COLLINS AVE
Practice Address - Street 2:
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-5305
Practice Address - Country:US
Practice Address - Phone:412-527-7165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Multi-Specialty