MEDICARE: MRS. MARY KATHERINE PLUMB PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	PT003164L	PA
2	2251P0200X	Pediatric Physical Therapist	006902-1	NY

General Provider Information

NPI Number	:	1346481108
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATHERINE PLUMB PT

Provider Business Mailing Address
First Line	:	7613 SUSAN DR
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-1223
Country	:	US
Telephone Number	:	315-458-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	7613 SUSAN DR
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-1223
Country	:	US
Telephone Number	:	315-458-5457
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/09/2009
Last Update Date	:	03/09/2009

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