Provider Demographics
NPI:1063734861
Name:HAUSER, MARY CLARK (MSPT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CLARK
Last Name:HAUSER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2002
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27293-2002
Mailing Address - Country:US
Mailing Address - Phone:336-239-4362
Mailing Address - Fax:336-764-9124
Practice Address - Street 1:119 MILL STREAM LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:NC
Practice Address - Zip Code:27292-6377
Practice Address - Country:US
Practice Address - Phone:336-239-4362
Practice Address - Fax:336-746-9124
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-20
Last Update Date:2010-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12545225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist