Provider Demographics
NPI:1063130839
Name:HANCOCK, MARY BRENNA (DPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BRENNA
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22207 COUNTY ROAD 279
Mailing Address - Street 2:
Mailing Address - City:PUXICO
Mailing Address - State:MO
Mailing Address - Zip Code:63960-8488
Mailing Address - Country:US
Mailing Address - Phone:573-778-6182
Mailing Address - Fax:
Practice Address - Street 1:955 E NINE MILE RD STE 107
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1706
Practice Address - Country:US
Practice Address - Phone:850-361-3650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic