Provider Demographics
NPI:1487012449
Name:KEARNS, MARYANN (DPT)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:KEARNS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MARYANN
Other - Middle Name:
Other - Last Name:INGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1050 INDUSTRIAL DR STE 210
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-2803
Mailing Address - Country:US
Mailing Address - Phone:302-389-7855
Mailing Address - Fax:302-449-2047
Practice Address - Street 1:100 S MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-1495
Practice Address - Country:US
Practice Address - Phone:302-389-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-05
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEJ1-0003329225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DED000029502Medicaid