Provider Demographics
NPI:1538634852
Name:MALLARI HEIM, MARIA ELENA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:ELENA
Last Name:MALLARI HEIM
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MARIA
Other - Middle Name:ELENA
Other - Last Name:MALLARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:38348 TRANQUILA AVE
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3224
Mailing Address - Country:US
Mailing Address - Phone:951-764-5176
Mailing Address - Fax:
Practice Address - Street 1:38348 TRANQUILA AVE
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-3224
Practice Address - Country:US
Practice Address - Phone:951-764-5176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT20233225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist