Individual
MALLORY ROSE NICHOLS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
4715 WHITESBURG DR SE, HUNTSVILLE, AL 35802-1632
(256) 881-5151
(256) 880-3939
Mailing address
1908 FLINT RD SE, DECATUR, AL 35601-6031
(256) 340-9708
(256) 340-9624
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PTH5864
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003819608
GROUP NPI
AL
05
—
529917620
—
AL
Enumeration date
07/22/2010
Last updated
02/25/2021
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