Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 1051555 | TX |
N | 225100000X | Physical Therapist | 944 | OK |
Y | 2251H1200X | Hand | 9410000128 | TX |
NPI | 1659336147 |
---|---|
Provider Name | Mary Mckinney Tyson |
First Address | Austin, TX 78759-5295 |
Second Address | Austin, TX 78759-5295 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 20/11/2019 |