MEDICARE: MARY E MCHUGH 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
1	225100000X	Physical Therapist	05001591A	IN
2	225100000X	Physical Therapist	LPT-31077	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265558191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E MCHUGH PT

Provider Business Mailing Address
First Line	:	1503 LIVINGSTON LAKES WAY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818
Country	:	US
Telephone Number	:	574-551-1148
Fax Number	:

Provider Business Practice Location Address
First Line	:	1503 LIVINGSTON LAKES WAY
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818
Country	:	US
Telephone Number	:	574-551-1148
Fax Number	:

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	05/09/2024

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