Individual
JENNA MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(630) 953-6778
(630) 953-6793
Mailing address
2160 S 1ST AVE, MAYWOOD, IL 60153-3328
(630) 953-6778
(630) 953-6793
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005491
IL
Other
Enumeration date
07/24/2012
Last updated
07/24/2012
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