Provider Demographics
NPI:1679917009
Name:MABRY, PAMELA LEE (LMT)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEE
Last Name:MABRY
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10895 COASTER LN
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77306-7149
Mailing Address - Country:US
Mailing Address - Phone:936-525-8405
Mailing Address - Fax:
Practice Address - Street 1:10895 COASTER LN
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77306-7149
Practice Address - Country:US
Practice Address - Phone:936-525-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT107989172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist