Individual
MARISSA MAIWELMAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
3801 COUNTY ROAD 3401, LONE OAK, TX 75453-4143
(903) 456-5323
Mailing address
3801 COUNTY ROAD 3401, LONE OAK, TX 75453-4143
(903) 456-5323
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
2127201
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZGP821864675
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/01/2018
Last updated
08/01/2018
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