Provider Demographics
NPI:1114634284
Name:SAYCON, MARY COURTNEY ANNE
Entity Type:Individual
Prefix:
First Name:MARY COURTNEY ANNE
Middle Name:
Last Name:SAYCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 28TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2899
Mailing Address - Country:US
Mailing Address - Phone:661-528-8843
Mailing Address - Fax:
Practice Address - Street 1:6640 IOLA AVE
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7845
Practice Address - Country:US
Practice Address - Phone:806-687-6640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2163939225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant