Provider Demographics
NPI:1295716520
Name:CLEARY, MARIE P (PT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:P
Last Name:CLEARY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 ROUTE 28
Mailing Address - Street 2:SUMMERFIELD PARK
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649-3303
Mailing Address - Country:US
Mailing Address - Phone:508-477-4800
Mailing Address - Fax:508-477-5377
Practice Address - Street 1:800 ROUTE 28
Practice Address - Street 2:SUMMERFIELD PARK
Practice Address - City:MASHPEE
Practice Address - State:MA
Practice Address - Zip Code:02649-3303
Practice Address - Country:US
Practice Address - Phone:508-477-4800
Practice Address - Fax:508-477-5377
Is Sole Proprietor?:No
Enumeration Date:2005-11-14
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA4969225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Y68297Medicare ID - Type Unspecified