Basic Information
| Provider Information | |||||||||
| NPI: | 1629021464 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DEPUTRON | ||||||||
| FirstName: | MARYANNE | ||||||||
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| Credential: | MSPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1265 WAYNE AVENUE, SUITE 308 | ||||||||
| Address2: | 119 PROFESSIONAL BUILDING | ||||||||
| City: | INDIANA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 157013508 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7248018095 | ||||||||
| FaxNumber: | 7248018147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1651-53 PULASKI HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | BEAR | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197011453 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3028341550 | ||||||||
| FaxNumber: | 3028341549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 07/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | J1-0001053 | DE | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | PT009263L | PA | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 20029500000 | 01 | DE | AMERIHEALTH | OTHER | 836024 | 01 | PA | BCBS | OTHER | 146334VLZ | 01 | PA | MEDICARE | OTHER | P00692858 | 01 | RAILROAD MEDICARE | OTHER | 1629021464 | 05 | DE | MEDICAID | 3556042 | 05 | MD | MEDICAID | AC44-0021 | 01 | DE | CAREFIRST | OTHER | 836024 | 01 | DE | HIGHMARK | OTHER |