MEDICARE: MARY MERWIN

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	6843	SC
2	225100000X	Physical Therapist	PT010703	GA

General Provider Information

NPI Number	:	1457606485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MERWIN

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:	630-575-6200
Fax Number	:

Provider Business Practice Location Address
First Line	:	1229 FRIENDSHIP RD STE 200
Second Line	:
City	:	BRASELTON
State	:	GA
Zip	:	30517-5608
Country	:	US
Telephone Number	:	770-415-9792
Fax Number	:	770-882-0268

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

Provider Enumeration Date	:	07/16/2012
Last Update Date	:	08/27/2025

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Directions to “ MARY MERWIN ” Practice Location

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