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General NPI Number Information
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NPI Number | 1427061274
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Entity Type | Individual
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Provider Name | MARYELLEN MAYNES PT
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5 N MEADOWS RD
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City | MEDFIELD
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State | MA
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Zip | 02052-2317
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Country | US
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Telephone | 508-359-9119
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Fax | 508-359-9115
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Provider Business Mailing Address
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Address Line | 372 CHAMBERLAIN ST
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City | HOLLISTON
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State | MA
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Zip | 01746-1529
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Country | US
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Telephone | 508-429-4787
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Fax | 508-429-1698
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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 | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number | PT5363
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License Number State | MA
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