Healthcare Provider Details

I. General information

NPI: 1275607079
Provider Name (Legal Business Name): MARY A WALSH MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6633 N MESA ST 212
EL PASO TX
79912-4427
US

IV. Provider business mailing address

6633 N MESA ST 212
EL PASO TX
79912-4427
US

V. Phone/Fax

Practice location:
  • Phone: 915-351-2299
  • Fax:
Mailing address:
  • Phone: 915-351-2299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMT3332
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT3332
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: