Provider Demographics
NPI:1194358937
Name:ROSE, MALLORY MCKAY (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:MCKAY
Last Name:ROSE
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 1:7191 CAHABA VALLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:BRIMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242
Mailing Address - Country:US
Mailing Address - Phone:205-408-6600
Mailing Address - Fax:205-408-6459
Practice Address - Street 1:7191 CAHABA VALLEY ROAD
Practice Address - Street 2:
Practice Address - City:BRIMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242
Practice Address - Country:US
Practice Address - Phone:205-408-6600
Practice Address - Fax:205-408-6459
Is Sole Proprietor?:No
Enumeration Date:2020-02-20
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH9731225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist