Provider Demographics
NPI:1750535191
Name:HUNTLEY, MARY-JANE
Entity type:Individual
Prefix:
First Name:MARY-JANE
Middle Name:
Last Name:HUNTLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 FIELDVIEW RD SO
Mailing Address - Street 2:
Mailing Address - City:QUEESBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804
Mailing Address - Country:US
Mailing Address - Phone:518-480-4224
Mailing Address - Fax:
Practice Address - Street 1:270 W CIRCULAR ST
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-6009
Practice Address - Country:US
Practice Address - Phone:518-583-3196
Practice Address - Fax:518-583-4157
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2009-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014653-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics