Provider Demographics
NPI:1811490725
Name:SCALISE, MARY MARGARET (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MARGARET
Last Name:SCALISE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 ALYSSA CIR
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-8202
Mailing Address - Country:US
Mailing Address - Phone:315-525-9201
Mailing Address - Fax:
Practice Address - Street 1:130 LOMOND CT
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5957
Practice Address - Country:US
Practice Address - Phone:315-437-4689
Practice Address - Fax:315-437-4698
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-16
Last Update Date:2018-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY023315-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist