Provider Demographics
NPI:1538406830
Name:MEHELIC, MARY ELIZABETH (PT)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:MEHELIC
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:BETSY
Other - Middle Name:
Other - Last Name:MEHELIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5793 WESTCHESTER FARM DR
Mailing Address - Street 2:
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-9118
Mailing Address - Country:US
Mailing Address - Phone:314-583-4224
Mailing Address - Fax:
Practice Address - Street 1:5793 WESTCHESTER FARM DR
Practice Address - Street 2:
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9118
Practice Address - Country:US
Practice Address - Phone:314-583-4224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO108116225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist