Provider Demographics
NPI:1245441237
Name:POPYLISEN, MARY K (PT, ATC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:POPYLISEN
Suffix:
Gender:F
Credentials:PT, ATC
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Mailing Address - Street 1:4436 HYACINTH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2816
Mailing Address - Country:US
Mailing Address - Phone:510-482-5510
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT EXT
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4300
Practice Address - Country:US
Practice Address - Phone:510-642-5651
Practice Address - Fax:510-643-5079
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA16912225100000X
CA806802255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Not Answered2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer