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General NPI Number Information
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NPI Number | 1255560611
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Entity Type | Individual
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Provider Name | MARY MAUREEN BASSOUS PT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 15 E HWY 260
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City | CAMP VERDE
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State | AZ
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Zip | 86322-2898
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Country | US
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Telephone | 928-567-6683
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Fax | 928-567-2477
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Provider Business Mailing Address
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Address Line | PO BOX 2898
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City | CAMP VERDE
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State | AZ
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Zip | 86322-2898
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Country | US
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Telephone | 928-567-6683
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Fax | 928-567-2477
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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 | 979
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License Number State | AZ
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