Individual
MISS MALLORY A. KELLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT, DPT
Contact information
Practice address
700 N LAKE AVE, TWIN LAKES, WI 53181-9436
(262) 877-2124
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100093769
—
WI
Enumeration date
07/26/2017
Last updated
10/03/2025
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