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NPI Code Detail

MEDICARE: TIKISHA LAVON MALLARD PT

MEDICARE: TIKISHA LAVON MALLARD PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist1157937TX

General Provider Information

NPI Number : 1518080480
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIKISHA LAVON MALLARD PT
Provider Business Mailing Address
First Line : 17130 POST OAK HOLW
Second Line :
City : SPRING
State : TX
Zip : 77379-8840
Country : US
Telephone Number : 832-384-8164
Fax Number :
Provider Business Practice Location Address
First Line : 4101 W ARKANSAS LN
Second Line :
City : ARLINGTON
State : TX
Zip : 76016-1496
Country : US
Telephone Number : 877-407-3422
Fax Number : 877-407-4329
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/07/2007
Last Update Date : 04/23/2025

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Directions to “ TIKISHA LAVON MALLARD PT” Practice Location

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