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NPI Code Detail

MEDICARE: MRS. MARY LOMONACO - HARIG PT

MEDICARE: MRS. MARY LOMONACO - HARIG PT
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
1225100000XPhysical Therapist5501002186MI

General Provider Information

NPI Number : 1104884519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY LOMONACO - HARIG PT
Provider Business Mailing Address
First Line : 18000 COVE STREET
Second Line : SUITE 202
City : SPRING LAKE
State : MI
Zip : 49456-1383
Country : US
Telephone Number : 616-847-1280
Fax Number : 616-847-1290
Provider Business Practice Location Address
First Line : 18000 COVE STREET
Second Line : SUITE 202
City : SPRING LAKE
State : MI
Zip : 49456-1383
Country : US
Telephone Number : 616-847-1280
Fax Number : 616-847-1290
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/01/2014

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