Healthcare Provider Details

I. General information

NPI: 1174907596
Provider Name (Legal Business Name): MARY HESSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 GARLAND LN N
PLYMOUTH MN
55447-1709
US

IV. Provider business mailing address

2630 GARLAND LN N
PLYMOUTH MN
55447-1709
US

V. Phone/Fax

Practice location:
  • Phone: 941-504-5771
  • Fax:
Mailing address:
  • Phone: 941-504-5771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: