Provider Demographics
NPI:1689916181
Name:MCFARLANE, MALLORY LEIGH (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:LEIGH
Last Name:MCFARLANE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:LEIGH
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:3300 N RUNNING CREEK WAY
Mailing Address - Street 2:BLDG B 150
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84043-5563
Mailing Address - Country:US
Mailing Address - Phone:801-766-4244
Mailing Address - Fax:801-766-4245
Practice Address - Street 1:3300 N RUNNING CREEK WAY
Practice Address - Street 2:BLDG B 150
Practice Address - City:LEHI
Practice Address - State:UT
Practice Address - Zip Code:84043-5563
Practice Address - Country:US
Practice Address - Phone:801-766-4244
Practice Address - Fax:801-766-4245
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.0198162251X0800X
UT9331370-24012251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004733OtherIOWA STATE LICENSE
IL070.019816OtherSTATE OF ILLINOIS PHYSICAL THERAPY LICENSE
UT9331370-2401OtherUTAH PT LICENSE