Provider Demographics
NPI:1396246575
Name:STALLWORTH, CAROL R (LMT # 129111)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:R
Last Name:STALLWORTH
Suffix:
Gender:F
Credentials:LMT # 129111
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:13111 WESTHEIMER RD STE 245
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-5526
Mailing Address - Country:US
Mailing Address - Phone:832-356-3107
Mailing Address - Fax:832-218-0793
Practice Address - Street 1:13111 WESTHEIMER RD STE 245
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-5526
Practice Address - Country:US
Practice Address - Phone:329-781-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-23
Last Update Date:2023-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX129111225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist