Provider Demographics
NPI:1366894222
Name:GARNER, MALLORY ANNE (ATC, LAT)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:ANNE
Last Name:GARNER
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:ANNE
Other - Last Name:SITZMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATC, LAT
Mailing Address - Street 1:5303 ATASCOCITA RD
Mailing Address - Street 2:#336
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-2800
Mailing Address - Country:US
Mailing Address - Phone:281-455-0364
Mailing Address - Fax:
Practice Address - Street 1:5303 ATASCOCITA RD
Practice Address - Street 2:#336
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-2800
Practice Address - Country:US
Practice Address - Phone:281-455-0364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT44832255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer