Provider Demographics
NPI:1700811445
Name:SAUNDERS, MARY KATE (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:KATE
Last Name:SAUNDERS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:906 GLENNEYRE ST
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2707
Mailing Address - Country:US
Mailing Address - Phone:949-494-2046
Mailing Address - Fax:949-494-2043
Practice Address - Street 1:906 GLENNEYRE ST
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2707
Practice Address - Country:US
Practice Address - Phone:949-494-2046
Practice Address - Fax:949-494-2043
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT15023225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16359Medicare ID - Type Unspecified