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Individual

MR. ROLAND FELICIANO MALLARE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man

Contact information

Practice address
1001 E PELLS ST, PAXTON, IL 60957-1300
(217) 379-4361
Mailing address
1001 E PELLS ST, PAXTON, IL 60957-1300
(217) 379-4361

Taxonomy

Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
160.005217
IL
225200000X
Physical Therapy Assistant
160005217
IL

Other

Enumeration date
11/10/2009
Last updated
04/16/2015
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