Provider Demographics
NPI:1720152440
Name:BELISSARY, MARY KAY (RPT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAY
Last Name:BELISSARY
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 CASHUA FERRY RD
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-8488
Mailing Address - Country:US
Mailing Address - Phone:843-777-4246
Mailing Address - Fax:843-777-4247
Practice Address - Street 1:701 CASHUA FERRY RD
Practice Address - Street 2:
Practice Address - City:DARLINGTON
Practice Address - State:SC
Practice Address - Zip Code:29532-8488
Practice Address - Country:US
Practice Address - Phone:843-777-4246
Practice Address - Fax:843-777-4247
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC795225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGPO334Medicaid
SCGPO334Medicaid