Healthcare Provider Details

I. General information

NPI: 1144860099
Provider Name (Legal Business Name): MARY T TURNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1078 S STATE ST STE 1
DOVER DE
19901-6902
US

IV. Provider business mailing address

170 LYNNHAVEN DR
DOVER DE
19904-4336
US

V. Phone/Fax

Practice location:
  • Phone: 302-401-7778
  • Fax:
Mailing address:
  • Phone: 302-423-2489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberJ2-0000131
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: