Provider Demographics
NPI:1700278082
Name:MAYO, CAROL ANN (LMT)
Entity Type:Individual
Prefix:MRS
First Name:CAROL
Middle Name:ANN
Last Name:MAYO
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 1:101 SUMMIT AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-2618
Mailing Address - Country:US
Mailing Address - Phone:682-556-2614
Mailing Address - Fax:817-870-1340
Practice Address - Street 1:101 SUMMIT AVE
Practice Address - Street 2:SUITE 114
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-2618
Practice Address - Country:US
Practice Address - Phone:682-556-2614
Practice Address - Fax:817-870-1340
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT041449225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist