Provider Demographics
NPI:1073919692
Name:WOOD, MARY (RTT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:WOOD
Suffix:
Gender:F
Credentials:RTT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9441 LBJ FWY STE 602
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75243-4545
Mailing Address - Country:US
Mailing Address - Phone:469-249-1883
Mailing Address - Fax:877-788-7505
Practice Address - Street 1:9441 LBJ FWY STE 602
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75243-4545
Practice Address - Country:US
Practice Address - Phone:469-249-1883
Practice Address - Fax:877-788-7505
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3509122471R0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471R0002XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiation Therapy