Provider Demographics
NPI:1114406790
Name:BELL, MALLORY (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:BELL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 N EASTMAN RD STE A
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664-2372
Mailing Address - Country:US
Mailing Address - Phone:772-214-7678
Mailing Address - Fax:
Practice Address - Street 1:1825 N EASTMAN RD STE A
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664-2372
Practice Address - Country:US
Practice Address - Phone:772-214-7678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11957225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist