Provider Demographics
NPI:1669464640
Name:ROURKE, MARY P (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:ROURKE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4225 JOHNSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8430
Mailing Address - Country:US
Mailing Address - Phone:828-397-6343
Mailing Address - Fax:828-433-2181
Practice Address - Street 1:1000 S STERLING ST
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-3938
Practice Address - Country:US
Practice Address - Phone:828-433-2276
Practice Address - Fax:828-433-2181
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC3030225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist