Provider Demographics
NPI:1780951756
Name:REYES, MARY M (LMT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:M
Last Name:REYES
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
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Mailing Address - Street 1:13041 HIGHWAY 6
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:TX
Mailing Address - Zip Code:77510-8161
Mailing Address - Country:US
Mailing Address - Phone:409-927-2866
Mailing Address - Fax:409-440-8157
Practice Address - Street 1:13041 HIGHWAY 6
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:TX
Practice Address - Zip Code:77510-8161
Practice Address - Country:US
Practice Address - Phone:409-927-2866
Practice Address - Fax:409-440-8157
Is Sole Proprietor?:No
Enumeration Date:2011-11-18
Last Update Date:2011-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXMT113847225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist