Provider Demographics
NPI:1174266282
Name:TANGPANTHONG, MAYUREE
Entity Type:Individual
Prefix:
First Name:MAYUREE
Middle Name:
Last Name:TANGPANTHONG
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 1:8646 RANNIE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77080-3526
Mailing Address - Country:US
Mailing Address - Phone:281-744-4114
Mailing Address - Fax:
Practice Address - Street 1:8646 RANNIE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77080-3526
Practice Address - Country:US
Practice Address - Phone:281-744-4114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-16
Last Update Date:2022-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT127445225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist