Provider Demographics
NPI:1588954960
Name:TERLIZZI, MARY JEAN K (PT)
Entity type:Individual
Prefix:
First Name:MARY JEAN
Middle Name:K
Last Name:TERLIZZI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:167 ROUTE 304
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BARDONIA
Mailing Address - State:NY
Mailing Address - Zip Code:10954-2050
Mailing Address - Country:US
Mailing Address - Phone:845-625-2810
Mailing Address - Fax:845-517-3486
Practice Address - Street 1:167 ROUTE 304
Practice Address - Street 2:SUITE 108
Practice Address - City:BARDONIA
Practice Address - State:NY
Practice Address - Zip Code:10954-2050
Practice Address - Country:US
Practice Address - Phone:845-625-2810
Practice Address - Fax:845-517-3486
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-19
Last Update Date:2017-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY010834-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist