Provider Demographics
NPI:1871859165
Name:RAHOE-WALLACE, MARY B (PT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:B
Last Name:RAHOE-WALLACE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:B
Other - Last Name:RAHOE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:7172 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1363
Mailing Address - Country:US
Mailing Address - Phone:720-495-0397
Mailing Address - Fax:
Practice Address - Street 1:1720 S BELLAIRE ST
Practice Address - Street 2:STE 325
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4304
Practice Address - Country:US
Practice Address - Phone:866-801-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL-2407225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist