Provider Demographics
NPI:1851562912
Name:MOHL, MARY-JO (MSPT)
Entity Type:Individual
Prefix:
First Name:MARY-JO
Middle Name:
Last Name:MOHL
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 STEVENS DR
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NH
Mailing Address - Zip Code:03833-6401
Mailing Address - Country:US
Mailing Address - Phone:301-442-3386
Mailing Address - Fax:
Practice Address - Street 1:800 SE CENTRAL PKWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3901
Practice Address - Country:US
Practice Address - Phone:772-287-9912
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18569225100000X
VA2305005251225100000X
NH3682225100000X
MA10158225100000X
FLPT29960225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist