Provider Demographics
NPI:1548304819
Name:POPE GRATTAN, MARY (PT, PHD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:POPE GRATTAN
Suffix:
Gender:F
Credentials:PT, PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:POPE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, PHD
Mailing Address - Street 1:3482 HYDE PARK WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-8206
Mailing Address - Country:US
Mailing Address - Phone:850-339-7709
Mailing Address - Fax:850-561-2457
Practice Address - Street 1:3482 HYDE PARK WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-8206
Practice Address - Country:US
Practice Address - Phone:850-339-7709
Practice Address - Fax:850-561-2457
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 19825174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist