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Individual

KELLY MALLOY

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
811 W EVERGREEN AVE, SUITE 306, CHICAGO, IL 60642-2682
(312) 242-1665
Mailing address
10016 OLCOTT AVE, SAINT JOHN, IN 46373-9547

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
070021220
IL

Other

Enumeration date
03/20/2015
Last updated
03/20/2015
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