Provider Demographics
NPI:1518056803
Name:MOWBRAY, MARJORIE KEELY (MSPT)
Entity type:Individual
Prefix:
First Name:MARJORIE
Middle Name:KEELY
Last Name:MOWBRAY
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SARA LN
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-8670
Mailing Address - Country:US
Mailing Address - Phone:717-372-8748
Mailing Address - Fax:
Practice Address - Street 1:36 SARA LN
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-8670
Practice Address - Country:US
Practice Address - Phone:717-372-8748
Practice Address - Fax:717-646-9995
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT0157092251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1009347620003OtherMA PROMISE PROVIDER#