Provider Demographics
NPI:1184350886
Name:MANSFIELD, MARY LEEN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LEEN
Last Name:MANSFIELD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:LEEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1177 QUEEN ST APT 4206
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4150
Mailing Address - Country:US
Mailing Address - Phone:843-991-6624
Mailing Address - Fax:
Practice Address - Street 1:7880 ALEXANDER PROMENADE PL STE 100
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-1918
Practice Address - Country:US
Practice Address - Phone:919-583-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIPT-5465225100000X
NCP22707225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist