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General NPI Number Information
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NPI Number | 1629021464
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Entity Type | Individual
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Provider Name | MARYANNE DEPUTRON MSPT
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Gender | Female
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 1651-53 PULASKI HIGHWAY
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City | BEAR
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State | DE
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Zip | 19701-1453
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Country | US
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Telephone | 302-834-1550
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Fax | 302-834-1549
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Provider Business Mailing Address
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Address Line | 1265 WAYNE AVENUE, SUITE 308 119 PROFESSIONAL BUILDING
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City | INDIANA
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State | PA
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Zip | 15701-3508
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Country | US
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Telephone | 724-801-8095
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Fax | 724-801-8147
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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 | J1-0001053
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License Number State | DE
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT009263L
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License Number State | PA
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