Provider Demographics
NPI:1821066366
Name:PEMENT, MARY LEE (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LEE
Last Name:PEMENT
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 1:725 VALLEY GRANDE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1576
Mailing Address - Country:US
Mailing Address - Phone:850-476-4917
Mailing Address - Fax:
Practice Address - Street 1:5827 HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32583-1763
Practice Address - Country:US
Practice Address - Phone:850-983-8583
Practice Address - Fax:850-983-8973
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT4834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist