Provider Demographics
NPI:1669588448
Name:PADGETT, MARY VICTORIA (PHYSICALTHERAPISTRPT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:VICTORIA
Last Name:PADGETT
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Gender:F
Credentials:PHYSICALTHERAPISTRPT
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Mailing Address - Street 1:1520 JENKS AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4646
Mailing Address - Country:US
Mailing Address - Phone:850-785-0264
Mailing Address - Fax:850-785-1410
Practice Address - Street 1:1520 JENKS AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4646
Practice Address - Country:US
Practice Address - Phone:850-785-0264
Practice Address - Fax:850-785-1410
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
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Provider Licenses
StateLicense IDTaxonomies
FL0001020225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106662Medicare ID - Type UnspecifiedPHYSICAL THERAPY