Individual
MALLORI CROCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ATC
Contact information
Practice address
801 6TH AVE, BOX 870308, TUSCALOOSA, AL 35487-1409
(205) 348-5832
(205) 348-9770
Mailing address
801 6TH AVE BOX 870308, TUSCALOOSA, AL 35487-1409
(205) 348-3607
(205) 348-4419
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
1537
AL
2255A2300X
Athletic Trainer
Primary
1537
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1537
LICENSURE #
AL
01
—
2000003186
BOC #
—
Enumeration date
11/26/2014
Last updated
12/22/2019
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