Provider Demographics
NPI:1437453024
Name:BERSCHAUER, MALLORY ELYSE (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:ELYSE
Last Name:BERSCHAUER
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 1:8750 GREENWOOD AVE N, S-1
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103
Mailing Address - Country:US
Mailing Address - Phone:206-782-5789
Mailing Address - Fax:206-782-5794
Practice Address - Street 1:701 N MILLER ST STE A
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-3904
Practice Address - Country:US
Practice Address - Phone:509-888-4088
Practice Address - Fax:509-888-3929
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT650165374225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist