Provider Demographics
NPI:1063530426
Name:SPICKARD, MARY F (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:F
Last Name:SPICKARD
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:F
Other - Last Name:SATKOSKI SPICKARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:10251 SOUTH US HWY 35
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:IN
Mailing Address - Zip Code:46532
Mailing Address - Country:US
Mailing Address - Phone:219-393-5930
Mailing Address - Fax:219-393-5638
Practice Address - Street 1:10251 US 35 SO
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:IN
Practice Address - Zip Code:46532
Practice Address - Country:US
Practice Address - Phone:219-393-5930
Practice Address - Fax:219-393-5638
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
05002122A2251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN122235OtherCSHCS