Provider Demographics
NPI:1134273337
Name:STANCU, MARY (MPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:STANCU
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:CHAVEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:400 N CORONADO ST
Mailing Address - Street 2:APT 2003
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-4183
Mailing Address - Country:US
Mailing Address - Phone:602-914-1332
Mailing Address - Fax:602-914-1335
Practice Address - Street 1:1016 N 32ND ST
Practice Address - Street 2:BLDG B
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85008-5107
Practice Address - Country:US
Practice Address - Phone:602-914-1332
Practice Address - Fax:602-914-1335
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ7480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist