Provider Demographics
NPI:1851357875
Name:DORMAN, MARY FRANCES (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:FRANCES
Last Name:DORMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:DORMAN
Other - Middle Name:
Other - Last Name:THERAPY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:MARY FRANCES DORMAN
Mailing Address - Street 2:7811 ACADEMY TRAIL NE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-3118
Mailing Address - Country:US
Mailing Address - Phone:505-259-4456
Mailing Address - Fax:505-797-1008
Practice Address - Street 1:DORMAN THERAPY
Practice Address - Street 2:7811 ACADEMY TRAIL NE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3118
Practice Address - Country:US
Practice Address - Phone:505-259-4456
Practice Address - Fax:505-797-1008
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM904225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM66529093Medicaid