Provider Demographics
NPI:1720393143
Name:VERLANDER, MARY BETH (MPT)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:VERLANDER
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 CREST VALLEY DR NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-4650
Mailing Address - Country:US
Mailing Address - Phone:770-500-3848
Mailing Address - Fax:678-868-1114
Practice Address - Street 1:3300 NORTHEAST EXPY NE
Practice Address - Street 2:BUILDING 8, SUITE C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-3932
Practice Address - Country:US
Practice Address - Phone:770-500-3848
Practice Address - Fax:678-868-1114
Is Sole Proprietor?:No
Enumeration Date:2010-08-10
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT004001225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist