Provider Demographics
NPI:1962791962
Name:MORTON, MARY E (PT)
Entity type:Individual
Prefix:MISS
First Name:MARY
Middle Name:E
Last Name:MORTON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:KOUBA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:15345 AMY PLZ
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-1585
Mailing Address - Country:US
Mailing Address - Phone:402-651-7744
Mailing Address - Fax:
Practice Address - Street 1:14705 W PLZ
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2518
Practice Address - Country:US
Practice Address - Phone:402-651-7744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-31
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9312251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE931OtherDEPARTMENT HEALTH AND HUMAN SERVICES/PHYSICAL THERAPY