Provider Demographics
NPI:1679957344
Name:THIGPEN, MARY T (PT)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:T
Last Name:THIGPEN
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 1:301 MAIN STREET SW
Mailing Address - Street 2:BRENAU UNIVERSITY, DEPARTMENT OF PHYSICAL THERAPY
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:678-971-1831
Mailing Address - Fax:
Practice Address - Street 1:301 MAIN STREET SW
Practice Address - Street 2:BRENAU UNIVERSITY, DEPARTMENT OF PHYSICAL THERAPY
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:678-971-1831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT001130261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy