Provider Demographics
NPI:1154775807
Name:HYDE, MARY E (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:HYDE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:3430 NEWBURG ROAD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2445
Mailing Address - Country:US
Mailing Address - Phone:502-451-6886
Mailing Address - Fax:502-458-2158
Practice Address - Street 1:3430 NEWBURG ROAD
Practice Address - Street 2:SUITE 111
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2445
Practice Address - Country:US
Practice Address - Phone:502-451-6886
Practice Address - Fax:502-458-2158
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY001811225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist