Healthcare Provider Details

I. General information

NPI: 1730522715
Provider Name (Legal Business Name): MARY A.L. GELDER D.P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 04/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 MULLET RUN
MILFORD DE
19963-5373
US

IV. Provider business mailing address

8205 W HOLLOW RD
NAPLES NY
14512-9547
US

V. Phone/Fax

Practice location:
  • Phone: 302-424-1810
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002968
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number033833
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number06824
License Number StateOR
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number24206
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: