Provider Demographics
NPI:1790116937
Name:HARBESON, MARY P (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:P
Last Name:HARBESON
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 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:DE
Mailing Address - Zip Code:19954-2001
Mailing Address - Country:US
Mailing Address - Phone:302-943-9538
Mailing Address - Fax:
Practice Address - Street 1:12 BROAD ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:DE
Practice Address - Zip Code:19954-2001
Practice Address - Country:US
Practice Address - Phone:302-943-9538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0000388225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist