Provider Demographics
NPI:1811005531
Name:THOMAS, MARY L (PT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:LYNN
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4101 MCEWEN RD STE 465
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75244-5129
Mailing Address - Country:US
Mailing Address - Phone:956-994-1700
Mailing Address - Fax:888-816-3627
Practice Address - Street 1:4101 MCEWEN RD STE 465
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75244-5129
Practice Address - Country:US
Practice Address - Phone:956-994-1700
Practice Address - Fax:888-816-3627
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDRPT-519225100000X
TN7343225100000X
TX1066694225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087740901Medicaid
TX87740901Medicaid