Provider Demographics
NPI:1801297619
Name:MAYMAN, MARLENE (LMT, CMT)
Entity type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:MAYMAN
Suffix:
Gender:F
Credentials:LMT, CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 WILLOWDALE DR
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:25443-4058
Mailing Address - Country:US
Mailing Address - Phone:304-283-7131
Mailing Address - Fax:
Practice Address - Street 1:129 W PATRICK ST STE 4
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-5682
Practice Address - Country:US
Practice Address - Phone:240-487-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019006932172M00000X
WV2013-3105172M00000X
MDM05146172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist