Provider Demographics
NPI:1184976656
Name:FREEMAN, MARY KATHARINE (RT, RVT RMSK)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATHARINE
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:RT, RVT RMSK
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:KATHARINE
Other - Last Name:GERLECZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1311 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:32444-2633
Mailing Address - Country:US
Mailing Address - Phone:850-896-7271
Mailing Address - Fax:
Practice Address - Street 1:2917 HIGHWAY 77
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-5013
Practice Address - Country:US
Practice Address - Phone:850-873-6748
Practice Address - Fax:850-913-1820
Is Sole Proprietor?:No
Enumeration Date:2012-10-09
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1594612471V0105X
4953692471S1302X
2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular Sonography
No2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography