Provider Demographics
NPI:1376272757
Name:DURNBAUGH, MALLORY (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:DURNBAUGH
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2175 E 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-3238
Mailing Address - Country:US
Mailing Address - Phone:970-593-9300
Mailing Address - Fax:970-593-9318
Practice Address - Street 1:2175 E 11TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3238
Practice Address - Country:US
Practice Address - Phone:970-593-9300
Practice Address - Fax:970-593-9318
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215050225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist