Provider Demographics
NPI:1669599494
Name:TREMBLAY, MARY EILEEN (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:EILEEN
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:TREMBLAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:120 MILLER RD
Mailing Address - Street 2:
Mailing Address - City:SINKING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:19608-1811
Mailing Address - Country:US
Mailing Address - Phone:610-927-0982
Mailing Address - Fax:
Practice Address - Street 1:560 VAN REED RD
Practice Address - Street 2:SUITE 204
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-1799
Practice Address - Country:US
Practice Address - Phone:610-988-4951
Practice Address - Fax:610-988-4952
Is Sole Proprietor?:No
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT001539E225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist