Provider Demographics
NPI:1841419769
Name:MERTZ, MARY KAREN (MPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAREN
Last Name:MERTZ
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 1:39570 SPANISH OAKS DR
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-8477
Mailing Address - Country:US
Mailing Address - Phone:951-314-4806
Mailing Address - Fax:
Practice Address - Street 1:39570 SPANISH OAKS DR
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-8477
Practice Address - Country:US
Practice Address - Phone:951-314-4806
Practice Address - Fax:951-696-3808
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28751174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist