Provider Demographics
NPI:1063388403
Name:SZCZSPONIK, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SZCZSPONIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10763 VILLAGER RD APT D
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-3942
Mailing Address - Country:US
Mailing Address - Phone:469-756-0517
Mailing Address - Fax:
Practice Address - Street 1:6211 W NORTHWEST HWY STE C253
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-3562
Practice Address - Country:US
Practice Address - Phone:469-756-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT147680225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist