Provider Demographics
NPI:1194728717
Name:HINDMAN, MARY J (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:J
Last Name:HINDMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-0948
Mailing Address - Country:US
Mailing Address - Phone:509-276-8811
Mailing Address - Fax:866-629-4801
Practice Address - Street 1:707 S PARK ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-0948
Practice Address - Country:US
Practice Address - Phone:509-276-8811
Practice Address - Fax:866-629-4801
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00002167174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8334187Medicaid
WA000300667Medicare ID - Type Unspecified
WA8334187Medicaid