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NPI Code Detail

MEDICARE: MARY PERDUE

MEDICARE: MARY PERDUE
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1629942065
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY PERDUE
Provider Business Mailing Address
First Line : 172 TAMWORTH RD
Second Line :
City : DENTON
State : NC
Zip : 27239-7014
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 234 CEDAR LODGE RD
Second Line :
City : THOMASVILLE
State : NC
Zip : 27360-6143
Country : US
Telephone Number : 336-474-2211
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2025
Last Update Date : 10/03/2025

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Directions to “ MARY PERDUE ” Practice Location

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