Individual
MR. JEFFREY DONALD MALLORY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MSPT
Contact information
Practice address
1200 MCCUTCHEN RD, ROLLA, MO 65401-2615
(573) 364-2311
Mailing address
1100 GRANDSIR AVE, ROLLA, MO 65401-3523
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
112290
MO
Other
Enumeration date
01/25/2010
Last updated
01/25/2010
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