MEDICARE: MRS. MARY MARIE PILGRIM-CARROZZA

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	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1275835266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY MARIE PILGRIM-CARROZZA

Provider Business Mailing Address
First Line	:	1027 S RAINBOW BLVD # 276
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6232
Country	:	US
Telephone Number	:	702-202-6894
Fax Number	:	702-202-6894

Provider Business Practice Location Address
First Line	:	1027 S RAINBOW BLVD # 276
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89145-6232
Country	:	US
Telephone Number	:	702-202-6894
Fax Number	:	702-202-6894

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	08/20/2015

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