Provider Demographics
NPI:1871659011
Name:MORRISSEY, MARY KATHLEEN (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KATHLEEN
Last Name:MORRISSEY
Suffix:
Gender:F
Credentials:PT
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Mailing Address - Street 1:101 MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-1930
Mailing Address - Country:US
Mailing Address - Phone:973-729-1222
Mailing Address - Fax:973-712-1220
Practice Address - Street 1:101 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-1930
Practice Address - Country:US
Practice Address - Phone:973-729-1222
Practice Address - Fax:973-712-1220
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NJ40QA00648300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ087995UHBMedicare ID - Type UnspecifiedMARY KATHLEEN MORRISSEY