Healthcare Provider Details

I. General information

NPI: 1316204555
Provider Name (Legal Business Name): MARY ELIZABETH FORET P.T,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 04/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8855 VALLEY RANCH PKWY W
IRVING TX
75063-4630
US

IV. Provider business mailing address

3129 FOX RUN DRIVE
GRAPEVINE TX
76051
US

V. Phone/Fax

Practice location:
  • Phone: 469-619-0847
  • Fax: 972-830-1726
Mailing address:
  • Phone: 817-684-0681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number1165098
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: