Provider Demographics
NPI:1679702559
Name:GAYAS, MARY CHARLENE DOCDOCIL (PT)
Entity type:Individual
Prefix:
First Name:MARY CHARLENE
Middle Name:DOCDOCIL
Last Name:GAYAS
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY CHARLENE
Other - Middle Name:
Other - Last Name:DOCDOCIL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9140 HIGHWAY 6 N APT 102
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77095-2479
Mailing Address - Country:US
Mailing Address - Phone:346-448-5167
Mailing Address - Fax:
Practice Address - Street 1:11110 BELLAIRE BLVD STE 240
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77072-2600
Practice Address - Country:US
Practice Address - Phone:888-880-9525
Practice Address - Fax:888-880-9525
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2022-02-19
Deactivation Date:2011-11-22
Deactivation Code:
Reactivation Date:2012-07-11
Provider Licenses
StateLicense IDTaxonomies
NY031121-1225100000X
TX1332901225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist