MEDICARE: MARY LARRY

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1588035596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LARRY

Provider Business Mailing Address
First Line	:	1807 FULTON DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-3939
Country	:	US
Telephone Number	:	772-828-5148
Fax Number	:	772-429-0733

Provider Business Practice Location Address
First Line	:	1807 FULTON DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-3939
Country	:	US
Telephone Number	:	772-828-5148
Fax Number	:	772-429-0733

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

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

Similar Medicare Providers

1790471621 — COMFORT RESIDENTIAL HOMES LLC
Practice Location Address:

1807 FULTON DR
FORT PIERCE, FL
34950-3939

Practice Phone: 772-828-6496
Practice Fax:

1588658140 — ANTHONY W GAMBILL A.T.C., CSCS
Practice Location Address:

2701 SPRING ST
FORT WAYNE, IN
46808-3939

Practice Phone: 260-399-7700
Practice Fax: 260-399-8164

1003149873 — MRS. KATHLEEN MARGARET BASS LPC
Practice Location Address:

3901 KIRBY DR , #1014
FORT WORTH, TX
76155-3939

Practice Phone: 817-915-0359
Practice Fax:

1225489255 — MIKE LIU DO
Practice Location Address:

900 JEROME ST STE 102
FORT WORTH, TX
76104-3939

Practice Phone: 817-924-6200
Practice Fax: 817-924-6201

1992434377 — CHARLES B FARMER II LPN
Practice Location Address:

3939 EASTGATE CT
NORTH FORT MYERS, FL
33917-7236

Practice Phone: 239-543-6099
Practice Fax:

1184486789 — THE HAVEN THERAPY, LLC
Practice Location Address:

3939 N WASHINGTON RD
FORT WAYNE, IN
46804-1817

Practice Phone: 765-667-0476
Practice Fax:

Directions to “ MARY LARRY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.