Provider Demographics
NPI:1740358084
Name:COE, MARY ELLEN (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:COE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:CLANCY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:825 WASHINGTON ST
Mailing Address - Street 2:STE 280 PHYSICAL THERAPY & SPORTS REHAB INC
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062
Mailing Address - Country:US
Mailing Address - Phone:781-769-2040
Mailing Address - Fax:781-769-1914
Practice Address - Street 1:825 WASHINGTON ST
Practice Address - Street 2:STE 280 PHYSICAL THERAPY & SPORTS REHAB INC
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-769-2040
Practice Address - Fax:781-769-1914
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
469439OtherTUFTS
469439OtherTUFTS