Healthcare Provider Details

I. General information

NPI: 1649369323
Provider Name (Legal Business Name): MARY ELLEN BARTON PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19531 COCHRAN BLVD
PORT CHARLOTTE FL
33948-2081
US

IV. Provider business mailing address

19531 COCHRAN BLVD
PORT CHARLOTTE FL
33948-2081
US

V. Phone/Fax

Practice location:
  • Phone: 941-255-3535
  • Fax: 941-766-7999
Mailing address:
  • Phone: 941-258-3291
  • Fax: 941-255-0584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT4583
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: