Basic Information
| Provider Information | |||||||||
| NPI: | 1659336147 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TYSON | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | MCKINNEY | ||||||||
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| Credential: | PT CHT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 SETON CENTER PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124391000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4700 SETON CENTER PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787595295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124391000 | ||||||||
| FaxNumber: | 5124391081 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 11/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2251H1200X | 9410000128 | TX | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Hand | 225100000X | 944 | OK | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 1051555 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.