Provider Demographics
NPI:1225300965
Name:WHEELER, MARY A (LMT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17000 EL CAMINO REAL
Mailing Address - Street 2:305A
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2636
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17000 EL CAMINO REAL
Practice Address - Street 2:305A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2636
Practice Address - Country:US
Practice Address - Phone:832-647-4369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-26
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT100190225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist