Marissa Maiwelmal, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

2127201 Issued in TX

Practice address

3801 County Road 3401
Lone Oak, TX 75453-4143

Phone

(903) 456-5323

NPI assigned

Aug 1, 2018

Last updated

Aug 1, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533081600000",
    "number": "1962980938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3801 COUNTY ROAD 3401",
            "city": "LONE OAK",
            "state": "TX",
            "postal_code": "754534143",
            "telephone_number": "903-456-5323"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3801 COUNTY ROAD 3401",
            "city": "LONE OAK",
            "state": "TX",
            "postal_code": "754534143",
            "telephone_number": "903-456-5323"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "406 S Main St",
            "address_purpose": "LOCATION",
            "city": "Winnsboro",
            "state": "TX",
            "postal_code": "754943226",
            "country_code": "US",
            "telephone_number": "903-342-6790",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAIWELMAL",
        "first_name": "MARISSA",
        "credential": "PTA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-01",
        "last_updated": "2018-08-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "TX",
            "license": "2127201",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "ZGP821864675",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bay Area Radiology, PC
• Meshell I Burden
• Lone Oak Isd
• Michelle Lee Lynch, LVN
• Marlee Satterwhite
• Kim Schonfeld
• Samantha Brooke Smith, DNP, APRN, FNP-C
• Southern Hospitality Care Services LLC
• The Studio Wellness & Co. PLLC

• Physical Therapy Assistant in Lone Oak, TX
• Providers in Lone Oak, TX by specialty
• Physical Therapy Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.