Provider Demographics
NPI:1720028079
Name:DOLAN, MARY K (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:K
Last Name:DOLAN
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 1:12 CENTER STREET
Mailing Address - Street 2:SUITE #1
Mailing Address - City:FREDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:14063-1804
Mailing Address - Country:US
Mailing Address - Phone:716-679-2233
Mailing Address - Fax:716-679-9698
Practice Address - Street 1:12 CENTER STREET
Practice Address - Street 2:SUITE #1
Practice Address - City:FREDONIA
Practice Address - State:NY
Practice Address - Zip Code:14063-1804
Practice Address - Country:US
Practice Address - Phone:716-679-2233
Practice Address - Fax:716-679-9698
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0272221225100000X
CO2897225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist