=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811005531
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY L. THOMAS PT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 06/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13747 MONTFORT DR STE 160
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-4497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-994-1700
-----------------------------------------------------
Fax | 888-816-3627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13747 MONTFORT DR STE 160
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75240-4497
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-225-8530
-----------------------------------------------------
Fax | 888-816-3627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | RPT-519
-----------------------------------------------------
License Number State | ID
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 7343
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 1066694
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------