Provider Demographics
NPI:1285438101
Name:MAGGARD, MALLORIE
Entity type:Individual
Prefix:
First Name:MALLORIE
Middle Name:
Last Name:MAGGARD
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 COUNTY ROAD 929
Mailing Address - Street 2:
Mailing Address - City:TEAGUE
Mailing Address - State:TX
Mailing Address - Zip Code:75860-5012
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:352 W US HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-4908
Practice Address - Country:US
Practice Address - Phone:903-389-7433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2186651225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant