Provider Demographics
NPI:1215286885
Name:CARD, MAE RESA (PT, DPT)
Entity type:Individual
Prefix:MS
First Name:MAE
Middle Name:RESA
Last Name:CARD
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MARCUS DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-4818
Mailing Address - Country:US
Mailing Address - Phone:315-512-1773
Mailing Address - Fax:315-512-1774
Practice Address - Street 1:3 OVERLOOK TRAIL
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:NY
Practice Address - Zip Code:10918-4655
Practice Address - Country:US
Practice Address - Phone:315-512-1773
Practice Address - Fax:315-512-1774
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035382225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist