Provider Demographics
NPI:1114267713
Name:MALLARI, AMAPOLA IMBAG (PHYSICAL THERAPIST)
Entity Type:Individual
Prefix:
First Name:AMAPOLA
Middle Name:IMBAG
Last Name:MALLARI
Suffix:
Gender:F
Credentials:PHYSICAL THERAPIST
Other - Prefix:
Other - First Name:AMAPOLA
Other - Middle Name:IMBAG
Other - Last Name:MALLARI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST
Mailing Address - Street 1:8711 VILLAGE DR STE 109
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5419
Mailing Address - Country:US
Mailing Address - Phone:210-297-2725
Mailing Address - Fax:
Practice Address - Street 1:8711 VILLAGE DR STE 109
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5419
Practice Address - Country:US
Practice Address - Phone:210-297-2725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2021-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1216477225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1216477OtherLICENSE