Provider Demographics
NPI:1134264377
Name:STICKLEY, MARY J (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:STICKLEY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1824 COWLING RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683-1408
Mailing Address - Country:US
Mailing Address - Phone:724-887-0555
Mailing Address - Fax:
Practice Address - Street 1:125 MARKET ST
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683-1903
Practice Address - Country:US
Practice Address - Phone:724-887-6615
Practice Address - Fax:724-887-6614
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001570L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist