Provider Demographics
NPI:1699363622
Name:CURTIS, MALLORY A (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:A
Last Name:CURTIS
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MALLORY
Other - Middle Name:A
Other - Last Name:EITEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:315 S OSTEOPATHY AVE
Mailing Address - Street 2:
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-6401
Mailing Address - Country:US
Mailing Address - Phone:660-785-1834
Mailing Address - Fax:660-785-1825
Practice Address - Street 1:502 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2437
Practice Address - Country:US
Practice Address - Phone:660-785-1834
Practice Address - Fax:660-785-1825
Is Sole Proprietor?:No
Enumeration Date:2021-01-05
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020042899225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist