Healthcare Provider Details

I. General information

NPI: 1932163672
Provider Name (Legal Business Name): MARY MUNDRANE MPT,ATC,CHT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 02/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 BEISER BLVD SUITE 103
DOVER DE
19904-7793
US

IV. Provider business mailing address

230 BEISER BLVD SUITE 103
DOVER DE
19904-7793
US

V. Phone/Fax

Practice location:
  • Phone: 302-736-0994
  • Fax: 302-736-5529
Mailing address:
  • Phone: 302-736-0994
  • Fax: 302-736-5529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ10000814
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License NumberJ10000814
License Number StateDE
# 3
Primary TaxonomyY
Taxonomy Code2251H1200X
TaxonomyHand Physical Therapist
License NumberJ10000814
License Number StateDE
# 4
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License NumberJ10000814
License Number StateDE
# 5
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberJ10000814
License Number StateDE
# 6
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberJ3-0000050
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: