Provider Demographics
NPI:1255678843
Name:MALLORY, CHERYL MONTE (LPTA)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:MONTE
Last Name:MALLORY
Suffix:
Gender:F
Credentials:LPTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8936 HOLLOW OAK DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-6871
Mailing Address - Country:US
Mailing Address - Phone:804-639-4829
Mailing Address - Fax:
Practice Address - Street 1:1600 WESTWOOD AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-4622
Practice Address - Country:US
Practice Address - Phone:804-474-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-15
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2306000144225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant