Provider Demographics
NPI:1790298677
Name:PRZYBYLA, MARY VIRGINIA (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:VIRGINIA
Last Name:PRZYBYLA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3319 JOLLY TOWN RD
Mailing Address - Street 2:
Mailing Address - City:CUBA
Mailing Address - State:NY
Mailing Address - Zip Code:14727-9405
Mailing Address - Country:US
Mailing Address - Phone:716-372-7647
Mailing Address - Fax:
Practice Address - Street 1:3319 JOLLYTOWN RD
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1472
Practice Address - Country:US
Practice Address - Phone:716-372-7647
Practice Address - Fax:716-372-7647
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012232-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist