Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | PT008642L | PA |
N | 2251N0400X | Physical Therapist - Neurology | PT008642L | PA |
NPI | 1346288172 |
---|---|
Provider Name | Kelly Mallon |
First Address | Irwin, PA 15642-9117 |
Second Address | Greensburg, PA 15601-3503 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01622275 | (05) | PA |