Individual
MARY JO GIVEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS,PT
Contact information
Practice address
144 BROWNDALE LN, SUITE 100, WIRTZ, VA 24184-3689
(630) 880-3502
Mailing address
144 BROWNDALE LN, SUITE 100, WIRTZ, VA 24184-3689
(630) 880-3502
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
070001936
IL
225100000X
Physical Therapist
Primary
2305206566
VA
2251G0304X
Geriatric Physical Therapist
070001936
IL
2251G0304X
Geriatric Physical Therapist
2305206566
VA
2251N0400X
Neurology Physical Therapist
070001936
IL
2251N0400X
Neurology Physical Therapist
2305206566
VA
Other
Enumeration date
09/01/2010
Last updated
09/01/2010
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