Individual
MARY C HOSTETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
3978 NEW VISION DR, FORT WAYNE, IN 46845-1712
(260) 373-9318
(260) 373-9301
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05009901A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100257920H
GROUP MEDICAID
IN
01
—
156546
GROUP MEDICARE
IN
05
—
200965610A
—
IN
Enumeration date
08/12/2009
Last updated
04/03/2024
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