Provider Demographics
NPI:1588976849
Name:AMBLER, MARY M (BSED, PTA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:M
Last Name:AMBLER
Suffix:
Gender:F
Credentials:BSED, PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 PHILLIPS TRL
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6425
Mailing Address - Country:US
Mailing Address - Phone:864-903-9687
Mailing Address - Fax:
Practice Address - Street 1:265 PHILLIPS TRL
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-6425
Practice Address - Country:US
Practice Address - Phone:864-903-9687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1561225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant