Individual
ANNETTE MACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
1400 N MAIN ST, GIDDINGS, TX 78942-1360
(979) 542-1755
Mailing address
1400 N MAIN ST, GIDDINGS, TX 78942-1360
(979) 542-1755
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2061100
TX
Other
Enumeration date
12/30/2014
Last updated
12/30/2014
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