Individual
MALLORY NEW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1390 S POTOMAC ST STE 114, AURORA, CO 80012-4529
(303) 745-6717
Mailing address
5511 PARMALEE GULCH RD # 211, INDIAN HILLS, CO 80454-4495
(706) 851-7176
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
PT34882
FL
225100000X
Physical Therapist
Primary
PTL.0018035
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PT34882
STATE LICENSE NUMBER
FL
Enumeration date
08/13/2019
Last updated
10/16/2023
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