Provider Demographics
NPI:1992871982
Name:THODE, MARY ANN (PT,MPT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:THODE
Suffix:
Gender:F
Credentials:PT,MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9364 E RAINTREE DR
Mailing Address - Street 2:STE 109
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-2200
Mailing Address - Country:US
Mailing Address - Phone:480-661-1124
Mailing Address - Fax:480-661-1125
Practice Address - Street 1:9364 E RAINTREE DR
Practice Address - Street 2:SUITE109
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-2200
Practice Address - Country:US
Practice Address - Phone:480-661-1124
Practice Address - Fax:480-661-1125
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ3847225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100386OtherPIN
AZ0463050OtherBCBS OF AZ
AZ2Z1802OtherHEALTH NET
AZZ100076Medicare ID - Type Unspecified
AZ100386OtherPIN