Individual
HEATHER F MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
810 LAKE CAROLINE DR, RUTHER GLEN, VA 22546-5315
(540) 645-8936
Mailing address
810 LAKE CAROLINE DR, RUTHER GLEN, VA 22546-5315
(540) 645-8936
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2000053207
ATC BOC NUMBER
—
01
—
7578-7643-0457
NATIONAL REGISTRY OF EMERGENCY MEDICAL TECHNICIANS
—
Enumeration date
05/05/2021
Last updated
05/22/2023
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