MEDICARE: DR. MARA JEANINE DRIGGERS DPT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	24157	MD
2	225100000X	Physical Therapist	6447	SC
3	225100000X	Physical Therapist	J1-0002902	DE

General Provider Information

NPI Number	:	1053660845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARA JEANINE DRIGGERS DPT

Provider Business Mailing Address
First Line	:	31326 FOUNDERS AVE
Second Line	:
City	:	SELBYVILLE
State	:	DE
Zip	:	19975-3728
Country	:	US
Telephone Number	:	410-952-3114
Fax Number	:

Provider Business Practice Location Address
First Line	:	232 MITCHELL ST
Second Line	:
City	:	MILLSBORO
State	:	DE
Zip	:	19966-9412
Country	:	US
Telephone Number	:	302-934-5830
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2012
Last Update Date	:	12/12/2016

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