Individual
MACIE ROSE SOUTHARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
4309 OLD JACKSBORO HWY STE 101, WICHITA FALLS, TX 76302-2700
(940) 386-1004
(940) 386-9944
Mailing address
4309 OLD JACKSBORO HWY STE 101, WICHITA FALLS, TX 76302-2700
(940) 386-1004
(940) 386-9944
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2173083
TX
Other
Enumeration date
10/26/2022
Last updated
10/26/2022
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