Provider Demographics
NPI:1700440500
Name:GARD, ALLYSON (OT)
Entity Type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:GARD
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 BAILEY AVE STE 360
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-2100
Mailing Address - Country:US
Mailing Address - Phone:504-273-9034
Mailing Address - Fax:
Practice Address - Street 1:3405 MIDWAY RD STE 500
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8139
Practice Address - Country:US
Practice Address - Phone:972-473-0229
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-26
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119954208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation