Provider Demographics
NPI:1659705663
Name:GRANT, MALLORY BETH (DPT)
Entity Type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:BETH
Last Name:GRANT
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:DR
Other - First Name:MALLORY
Other - Middle Name:BETH
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:3231 MAIN ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BRYANT
Mailing Address - State:AR
Mailing Address - Zip Code:72022-9188
Mailing Address - Country:US
Mailing Address - Phone:501-847-0500
Mailing Address - Fax:501-847-0508
Practice Address - Street 1:3231 MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022-9188
Practice Address - Country:US
Practice Address - Phone:501-847-0500
Practice Address - Fax:501-847-0508
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPT3737225100000X
ARPT 3737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist