Healthcare Provider Details

I. General information

NPI: 1235418054
Provider Name (Legal Business Name): MARY T. HOTALING P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 ELIZABETH STREET
FRANKFORT NY
13340
US

IV. Provider business mailing address

120 ELIZABETH STREET
FRANKFORT NY
13340
US

V. Phone/Fax

Practice location:
  • Phone: 315-894-5095
  • Fax: 310-894-8762
Mailing address:
  • Phone: 315-894-5095
  • Fax: 310-894-8762

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number021252-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: