Provider Demographics
NPI:1710755954
Name:ARMINIO, MARY TYLER
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:TYLER
Last Name:ARMINIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2450 VILLAGE PROFESSIONAL DR N
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-4734
Mailing Address - Country:US
Mailing Address - Phone:334-528-1964
Mailing Address - Fax:
Practice Address - Street 1:2450 VILLAGE PROFESSIONAL DR N
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-4734
Practice Address - Country:US
Practice Address - Phone:334-528-1964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4424208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty