Provider Demographics
NPI:1003402421
Name:MAYHEW, ANN MICHELLE (PT)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:MICHELLE
Last Name:MAYHEW
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8214 CIRCLEVIEW ST
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-4775
Mailing Address - Country:US
Mailing Address - Phone:214-952-0357
Mailing Address - Fax:
Practice Address - Street 1:819 E MOORE AVE STE C
Practice Address - Street 2:
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-3230
Practice Address - Country:US
Practice Address - Phone:972-551-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-20
Last Update Date:2020-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1060184225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1060184OtherSTATE LICENSE