Provider Demographics
NPI:1760583447
Name:PROULX, MARY H (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:H
Last Name:PROULX
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 1:225R KING ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2361
Mailing Address - Country:US
Mailing Address - Phone:413-586-2300
Mailing Address - Fax:413-584-2221
Practice Address - Street 1:225R KING ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2361
Practice Address - Country:US
Practice Address - Phone:413-586-2300
Practice Address - Fax:413-584-2221
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA294300OtherCONNECTICARE
MAY65765OtherBLUECROSS
MA294300OtherCONNECTICARE