Healthcare Provider Details

I. General information

NPI: 1457689655
Provider Name (Legal Business Name): MARY MERCURIO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/27/2009
Last Update Date: 03/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 FINNELL DR
WEYMOUTH MA
02188-1110
US

IV. Provider business mailing address

99 LONGWATER CIR STE 201
NORWELL MA
02061-1643
US

V. Phone/Fax

Practice location:
  • Phone: 781-335-1151
  • Fax: 781-335-7851
Mailing address:
  • Phone: 617-657-5921
  • Fax: 781-986-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number18678
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: