MEDICARE: MAE WILEEN MERCADO ROONEY 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	011583	GA
2	225100000X	Physical Therapist	PT011583	GA

General Provider Information

NPI Number	:	1730598939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAE WILEEN MERCADO ROONEY PT

Provider Business Mailing Address
First Line	:	2496 NORWOOD PARK XING
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-1856
Country	:	US
Telephone Number	:	863-602-0823
Fax Number	:

Provider Business Practice Location Address
First Line	:	2496 NORWOOD PARK XING
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30340-1856
Country	:	US
Telephone Number	:	863-602-0823
Fax Number	:

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

Provider Enumeration Date	:	08/13/2014
Last Update Date	:	07/21/2025

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