Provider Demographics
NPI:1548961485
Name:NUNENMACHER, MARY (LPTA)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NUNENMACHER
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WINDSOR SHORES DR APT 13H
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-1714
Mailing Address - Country:US
Mailing Address - Phone:228-218-0328
Mailing Address - Fax:
Practice Address - Street 1:1330 KINARD ST
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:SC
Practice Address - Zip Code:29108-3038
Practice Address - Country:US
Practice Address - Phone:803-276-2601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4967225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant