Provider Demographics
NPI:1700051109
Name:PRICE, MARY ANN (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:PRICE
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 1:1076 W CHANDLER BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-5225
Mailing Address - Country:US
Mailing Address - Phone:480-821-1997
Mailing Address - Fax:480-821-1887
Practice Address - Street 1:1076 W CHANDLER BLVD
Practice Address - Street 2:STE 103
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-5225
Practice Address - Country:US
Practice Address - Phone:480-821-1997
Practice Address - Fax:480-821-1887
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13871225100000X
AZ9573174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT 13871OtherWAITING FOR NPI NUMBER TO APPLY FOR MEDICARE NUMBER
AZ9573OtherAZ STATE LICENSE