Provider Demographics
NPI:1881890887
Name:COX, MARY ELIZABETH (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:COX
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 1:1939 CONTINENTAL AVE
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-4125
Mailing Address - Country:US
Mailing Address - Phone:949-226-9681
Mailing Address - Fax:
Practice Address - Street 1:2900 BRISTOL ST
Practice Address - Street 2:J107
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-5981
Practice Address - Country:US
Practice Address - Phone:949-226-9681
Practice Address - Fax:949-627-8081
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18971174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT18971OtherPHYSICAL THERAPIST