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General NPI Number Information
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NPI Number | 1033208236
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Entity Type | Individual
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Provider Name | MARY JO MCNAMARA PT, ATC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1381 JEFFERSON RD
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City | NORTHFIELD
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State | MN
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Zip | 55057-3080
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Country | US
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Telephone | 507-646-8809
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Fax | 507-646-8801
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Provider Business Mailing Address
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Address Line | 1705 ALDRICH CT
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City | NORTHFIELD
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State | MN
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Zip | 55057-3912
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Country | US
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Telephone | 507-645-0212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2967
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License Number State | MN
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