Provider Demographics
NPI:1750665642
Name:MALLET, TJ (LMT)
Entity Type:Individual
Prefix:MS
First Name:TJ
Middle Name:
Last Name:MALLET
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3327 COCOPLUM CIR
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33063-5910
Mailing Address - Country:US
Mailing Address - Phone:954-234-3299
Mailing Address - Fax:
Practice Address - Street 1:3327 COCOPLUM CIR
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33063-5910
Practice Address - Country:US
Practice Address - Phone:954-234-3299
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA24266225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist