Basic Information
| Provider Information | |||||||||
| NPI: | 1295964617 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SEXTON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | VANN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 W WINDSOR ST | ||||||||
| Address2: | |||||||||
| City: | DEMOPOLIS | ||||||||
| State: | AL | ||||||||
| PostalCode: | 367323617 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3342892741 | ||||||||
| FaxNumber: | 3342894511 | ||||||||
| Practice Location | |||||||||
| Address1: | 245 CAHABA VALLEY PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | PELHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 351242217 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059426820 | ||||||||
| FaxNumber: | 2053425884 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2009 | ||||||||
| LastUpdateDate: | 07/07/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PTH4563 | AL | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.