Mary Euvette Wilson-Shaler, LMT
Individual provider Active NPI Massage Therapist · Portland, TX
NPI 1619745205 · NPPES record last updated Jul 12, 2024
Key facts
- NPI
- 1619745205
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Massage Therapist 225700000X
- License
- MT014540 (TX)
- Practice address
- 607 Railroad Dr
Portland, TX 78374-1539 - Phone
- (361) 502-1793
- NPI assigned
- Dec 13, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT014540 | TX | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Faithful Modalities Medical Massage LLC | Massage Therapist | Current |
Accepting new patients |
| Hands of Grace Massage Therapy | Massage Therapist | Past |
Accepting new patients |
Locations
607 Railroad Dr
Portland, TX 78374
Phone (361) 502-1793
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Massage Therapist | 225700000X | MT014540 | TX | Yes |
Addresses
Primary practice location
607 Railroad Dr
Portland, TX 78374-1539
Mailing address
PO Box 1246
Ingleside, TX 78362-1246
Phone (361) 563-3578
Other providers in Portland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.