Provider Demographics
NPI:1992137897
Name:ZUMPFE, MARY ANN MARCELLA (LMT)
Entity type:Individual
Prefix:
First Name:MARY ANN
Middle Name:MARCELLA
Last Name:ZUMPFE
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 TIBURON DRIVE
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588
Mailing Address - Country:US
Mailing Address - Phone:843-215-0892
Mailing Address - Fax:
Practice Address - Street 1:424 TIBURON DR
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-6984
Practice Address - Country:US
Practice Address - Phone:843-215-0892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-01
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5709172M00000X, 173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist
No173C00000XOther Service ProvidersReflexologist