Individual
MRS. DESIREE MAILENE PENA MALLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
330 W BEN WHITE BLVD, AUSTIN, TX 78704-8095
(512) 730-4800
Mailing address
148 RAVELLO ST, LIBERTY HILL, TX 78642-2306
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2165191
TX
Other
Enumeration date
05/19/2026
Last updated
05/19/2026
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