Provider Demographics
NPI:1457334146
Name:THRIFT, MARY ANN GRAHAM (MSPT)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:GRAHAM
Last Name:THRIFT
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12040 SOUTH JOG ROAD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-8282
Mailing Address - Country:US
Mailing Address - Phone:305-331-4922
Mailing Address - Fax:305-331-4922
Practice Address - Street 1:12040 S JOG RD
Practice Address - Street 2:SUITE 8
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4164
Practice Address - Country:US
Practice Address - Phone:305-331-4922
Practice Address - Fax:954-272-0554
Is Sole Proprietor?:No
Enumeration Date:2005-11-28
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT18757225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U5730ZMedicare ID - Type Unspecified