Provider Demographics
NPI:1568756583
Name:NGUYEN, MARY ELLEN SOLIS (PT, MS)
Entity Type:Individual
Prefix:MRS
First Name:MARY ELLEN
Middle Name:SOLIS
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PT, MS
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:ELLEN
Other - Last Name:SOLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, MS
Mailing Address - Street 1:PO BOX 835613
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75083-5613
Mailing Address - Country:US
Mailing Address - Phone:214-679-3891
Mailing Address - Fax:469-405-2994
Practice Address - Street 1:16250 KNOLL TRAIL DR STE 101
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2868
Practice Address - Country:US
Practice Address - Phone:214-679-3891
Practice Address - Fax:469-405-2994
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1153291225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1346875275OtherORGANIZATIONAL NPI
TX1568756583OtherNPI
TX1153291OtherTEXAS PHYSICAL THERAPY BOARD OF EXAMINERS