Healthcare Provider Details

I. General information

NPI: 1467528240
Provider Name (Legal Business Name): MARY LYNN ENGROFF P.T., P.A.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7595 LAKE WORTH RD
LAKE WORTH FL
33467-2532
US

IV. Provider business mailing address

4774 S CLASSICAL BLVD
DELRAY BEACH FL
33445-1225
US

V. Phone/Fax

Practice location:
  • Phone: 561-433-2564
  • Fax:
Mailing address:
  • Phone: 561-346-9162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number7384
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9102324
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: