Provider Demographics
NPI:1629660303
Name:MALLARI, CHARLTON (PT, DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CHARLTON
Middle Name:
Last Name:MALLARI
Suffix:
Gender:M
Credentials:PT, DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:614 CLARADAY ST
Mailing Address - Street 2:
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6050
Mailing Address - Country:US
Mailing Address - Phone:626-373-5547
Mailing Address - Fax:
Practice Address - Street 1:1520 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3930
Practice Address - Country:US
Practice Address - Phone:323-725-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist