Provider Demographics
NPI:1447700521
Name:MURPHY, MARY M (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:MURPHY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:DMAHONEY
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:6974 N ARDARA AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53209-2911
Mailing Address - Country:US
Mailing Address - Phone:414-351-5810
Mailing Address - Fax:
Practice Address - Street 1:8901 W LINCOLN AVE
Practice Address - Street 2:OP REHAB GROUND FLOOR
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2409
Practice Address - Country:US
Practice Address - Phone:414-328-6640
Practice Address - Fax:414-328-8551
Is Sole Proprietor?:No
Enumeration Date:2016-10-12
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1895-24225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist