Provider Demographics
NPI:1932163672
Name:MUNDRANE, MARY (MPT,ATC,CHT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MUNDRANE
Suffix:
Gender:F
Credentials:MPT,ATC,CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 BEISER BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-7793
Mailing Address - Country:US
Mailing Address - Phone:302-736-0994
Mailing Address - Fax:302-736-5529
Practice Address - Street 1:230 BEISER BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-7793
Practice Address - Country:US
Practice Address - Phone:302-736-0994
Practice Address - Fax:302-736-5529
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ10000814225100000X, 2251G0304X, 2251H1200X, 2251S0007X, 2251X0800X
DEJ3-00000502255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251H1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistHand
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEP00294512OtherMEDICARE RAILROAD
DE0717329000OtherAMERIHEALTH
DEP00294512OtherMEDICARE RAILROAD
DE011723S39Medicare ID - Type Unspecified