Provider Demographics
NPI:1568683217
Name:STULTZ-WARE, MARY (LPTA)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:STULTZ-WARE
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 TREMONT ST
Mailing Address - Street 2:#B
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214
Mailing Address - Country:US
Mailing Address - Phone:817-992-7517
Mailing Address - Fax:
Practice Address - Street 1:8615 FREEPORT PRKY
Practice Address - Street 2:#225
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063
Practice Address - Country:US
Practice Address - Phone:972-812-3299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2018891225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant