Provider Demographics
NPI:1447323324
Name:MATHRE, MARILYN LENHERT (PT)
Entity type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:LENHERT
Last Name:MATHRE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:239 REVERE ST
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91784-1364
Mailing Address - Country:US
Mailing Address - Phone:909-982-0705
Mailing Address - Fax:909-982-7026
Practice Address - Street 1:17487 HURLEY ST
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91744-5106
Practice Address - Country:US
Practice Address - Phone:626-935-7723
Practice Address - Fax:626-912-1696
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7612225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist