Provider Demographics
NPI:1699778845
Name:DAULONG, MARY R (PT)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:R
Last Name:DAULONG
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:15814 CHAMPION FOREST DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-7141
Mailing Address - Country:US
Mailing Address - Phone:281-866-9505
Mailing Address - Fax:281-587-9791
Practice Address - Street 1:15814 CHAMPION FOREST DR
Practice Address - Street 2:STE 240
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7141
Practice Address - Country:US
Practice Address - Phone:281-866-9505
Practice Address - Fax:281-587-9791
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1008928225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0019105OtherBCBS BLUE LINK
TX8T0825OtherBCBS PAR PLAN PROVIDER #
TX8A4376Medicare PIN