Provider Demographics
NPI:1720253248
Name:MOUNTS, MARY BETH (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:MOUNTS
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:428 SHREWSBURY ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1701
Mailing Address - Country:US
Mailing Address - Phone:304-533-4788
Mailing Address - Fax:
Practice Address - Street 1:428 SHREWSBURY ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1701
Practice Address - Country:US
Practice Address - Phone:304-533-4788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2003-1135225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist