Provider Demographics
NPI:1841328465
Name:ZANELLI, MARY FORD (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:FORD
Last Name:ZANELLI
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 1:8165 E DEL BARQUERO DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-2348
Mailing Address - Country:US
Mailing Address - Phone:480-991-2461
Mailing Address - Fax:480-368-0839
Practice Address - Street 1:8165 E DEL BARQUERO DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-2348
Practice Address - Country:US
Practice Address - Phone:480-991-2461
Practice Address - Fax:480-368-0839
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0327225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ781832Medicaid