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General NPI Number Information
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NPI Number | 1144704859
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Entity Type | Individual
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Provider Name | CURTIS MONTGOMERY MAYO JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 09/18/2018
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Last Update Date | 09/18/2018
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Provider Practice Location Address
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Address Line | 300 E BAKER ST
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City | CLARKSVILLE
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State | TX
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Zip | 75426-5034
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Country | US
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Telephone | 903-348-2915
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Fax |
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Provider Business Mailing Address
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Address Line | 168 COUNTY ROAD 1142
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City | CUMBY
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State | TX
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Zip | 75433-6627
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Country | US
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Telephone | 903-348-2915
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number |
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License Number State |
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