Provider Demographics
NPI:1376102855
Name:KALINOSKI, MALLORY (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:KALINOSKI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:
Other - Last Name:VETTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2203 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5016
Mailing Address - Country:US
Mailing Address - Phone:941-408-0670
Mailing Address - Fax:941-408-0160
Practice Address - Street 1:5980 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34231-3930
Practice Address - Country:US
Practice Address - Phone:941-721-1854
Practice Address - Fax:941-721-1859
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT34604225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist