Individual
MALLORY FAHNESTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Contact information
Practice address
1506 W SAINT JOSEPH ST, PERRYVILLE, MO 63775-1504
(573) 517-7900
Mailing address
1506 W SAINT JOSEPH ST, PERRYVILLE, MO 63775-1504
(573) 517-7900
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
2014004288
MO
Other
Enumeration date
02/12/2014
Last updated
02/12/2014
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