| NPI | 1013386077 |
|---|---|
| Former Name | MARY MAYVILLE |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MI 5501017410) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1316376) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2023-06-12 |