Healthcare Provider Details

I. General information

NPI: 1437466224
Provider Name (Legal Business Name): MARY JO GIVEN MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JO GIVEN MS,PT

II. Dates (important events)

Enumeration Date: 09/01/2010
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 BROWNDALE LN SUITE 100
WIRTZ VA
24184-3689
US

IV. Provider business mailing address

144 BROWNDALE LN SUITE 100
WIRTZ VA
24184-3689
US

V. Phone/Fax

Practice location:
  • Phone: 630-880-3502
  • Fax:
Mailing address:
  • Phone: 630-880-3502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305206566
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070001936
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number2305206566
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number070001936
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number2305206566
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License Number070001936
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: