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General NPI Number Information
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NPI Number | 1689030041
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Entity Type | Individual
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Provider Name | MARY DENTON
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Gender | Female
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Dates
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Enumeration Date | 01/14/2016
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Last Update Date | 01/14/2016
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Provider Practice Location Address
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Address Line | 328 MALLORY LN
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City | STARKVILLE
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State | MS
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Zip | 39759-7126
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Country | US
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Telephone | 601-513-1050
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Fax |
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Provider Business Mailing Address
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Address Line | 328 MALLORY LN
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City | STARKVILLE
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State | MS
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Zip | 39759-7126
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Country | US
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Telephone | 601-513-1050
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | PTA5309
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License Number State | MS
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