Provider Demographics
NPI:1396090122
Name:NEWSOME, MARY BETH (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:NEWSOME
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETH
Other - Last Name:OZMENT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:860 OMNI BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4430
Mailing Address - Country:US
Mailing Address - Phone:757-223-9403
Mailing Address - Fax:757-223-5546
Practice Address - Street 1:1481 KELLY RD
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-9572
Practice Address - Country:US
Practice Address - Phone:919-296-8180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305214493225100000X
GA225100000X
NCP19473225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist