Individual
MALLORY RAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1501 KINGS HWY, SHREVEPORT, LA 71103-4228
(318) 626-0000
Mailing address
2605 ROSEDALE PL, BOSSIER CITY, LA 71111-3458
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
12179
LA
Other
Enumeration date
09/29/2025
Last updated
09/29/2025
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