Provider Demographics
NPI:1245372978
Name:PENGELLEY, MARY BAKER (RPT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BAKER
Last Name:PENGELLEY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5641 GRAMERCY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-1663
Mailing Address - Country:US
Mailing Address - Phone:561-686-7727
Mailing Address - Fax:561-686-7727
Practice Address - Street 1:THE ARC OF PALM BEACH COUNTY
Practice Address - Street 2:1201 AUSTRALIAN AVE.
Practice Address - City:RIVIERA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33404
Practice Address - Country:US
Practice Address - Phone:561-842-3213
Practice Address - Fax:561-863-4352
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLPT57752251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics