Individual
OSCAR MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
601 CHILDRENS LN, NORFOLK, VA 23507-1910
(757) 668-7000
Mailing address
325 CONGRESS AVE, HAMPTON, VA 23669-4665
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0126001263
VA
Other
Enumeration date
12/20/2012
Last updated
12/20/2012
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