Provider Demographics
NPI:1356433866
Name:HARRINGTON, MARY BETH (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:HARRINGTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:BAUMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6896 S GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48838-1081
Mailing Address - Country:US
Mailing Address - Phone:616-754-2943
Mailing Address - Fax:616-754-2948
Practice Address - Street 1:6896 S GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MI
Practice Address - Zip Code:48838-1081
Practice Address - Country:US
Practice Address - Phone:616-754-2943
Practice Address - Fax:616-754-2948
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016102225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK25018Medicare PIN