Provider Demographics
NPI:1912117292
Name:MARSDEN, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MARSDEN
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:PO BOX 63
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18921-0063
Mailing Address - Country:US
Mailing Address - Phone:610-405-5305
Mailing Address - Fax:
Practice Address - Street 1:3500 HIGH POINT BLVD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7803
Practice Address - Country:US
Practice Address - Phone:610-264-5724
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001039E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist