Healthcare Provider Details

I. General information

NPI: 1346875275
Provider Name (Legal Business Name): MARY ELLEN NGUYEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2020
Last Update Date: 03/08/2025
Certification Date: 03/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16250 KNOLL TRAIL DR STE 101
DALLAS TX
75248-2868
US

IV. Provider business mailing address

PO BOX 835613
RICHARDSON TX
75083-5613
US

V. Phone/Fax

Practice location:
  • Phone: 214-679-3891
  • Fax: 469-405-2994
Mailing address:
  • Phone: 214-679-3891
  • Fax: 469-405-2994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: MARY ELLEN SOLIS NGUYEN
Title or Position: OWNER, CEO, PHYSICAL THERAPIST
Credential: MS, PT
Phone: 214-679-3891