Provider Demographics
NPI:1942218169
Name:MALLETT, CHRISTOPHER MARK (DPT)
Entity Type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:MARK
Last Name:MALLETT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1942 HUNTINGTON DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4959
Mailing Address - Country:US
Mailing Address - Phone:626-403-6545
Mailing Address - Fax:626-441-7660
Practice Address - Street 1:1942 HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4959
Practice Address - Country:US
Practice Address - Phone:626-403-6545
Practice Address - Fax:626-441-7660
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT24744225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP58256Medicare UPIN
CAWPT24744BMedicare ID - Type Unspecified