Provider Demographics
NPI:1710227277
Name:BEHENNA, MALLORY TYLER (PT, DPT)
Entity Type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:TYLER
Last Name:BEHENNA
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 W UNIVERSITY DR
Mailing Address - Street 2:SUITE 119
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3392
Mailing Address - Country:US
Mailing Address - Phone:972-569-8860
Mailing Address - Fax:972-569-9746
Practice Address - Street 1:1705 W UNIVERSITY DR
Practice Address - Street 2:SUITE 119
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3392
Practice Address - Country:US
Practice Address - Phone:972-569-8860
Practice Address - Fax:972-569-9746
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1226871225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist