Provider Demographics
NPI:1104393271
Name:MCDONALD, STANLEY BARRON (LMT)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:BARRON
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2990 RICHMOND AVE STE 440
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-3113
Mailing Address - Country:US
Mailing Address - Phone:832-526-6520
Mailing Address - Fax:
Practice Address - Street 1:2990 RICHMOND AVE STE 440
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3113
Practice Address - Country:US
Practice Address - Phone:832-526-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-26
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX029219225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist