Provider Demographics
NPI:1881692846
Name:GINGERICH, MARY ANNE (PT)
Entity type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:GINGERICH
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 1:49 PRINCE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17109-3113
Mailing Address - Country:US
Mailing Address - Phone:717-901-9487
Mailing Address - Fax:717-901-9488
Practice Address - Street 1:49 PRINCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17109-3113
Practice Address - Country:US
Practice Address - Phone:717-901-9487
Practice Address - Fax:717-901-9488
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT003604L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA034581MV7Medicare ID - Type UnspecifiedMC PROVIDER NUMBER