Provider Demographics
NPI:1821761529
Name:THOMAS, MARY HUNTINGTON (CNIM)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HUNTINGTON
Last Name:THOMAS
Suffix:
Gender:F
Credentials:CNIM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 SOUTHWEST FWY STE 410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77027-7422
Mailing Address - Country:US
Mailing Address - Phone:713-626-2337
Mailing Address - Fax:469-453-3374
Practice Address - Street 1:4141 SOUTHWEST FWY STE 410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7422
Practice Address - Country:US
Practice Address - Phone:713-626-2337
Practice Address - Fax:469-453-3374
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-28
Last Update Date:2021-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1191246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
Provider Identifiers
StateIdentifier IDID TypeIssuer
1191OtherCNIM