Provider Demographics
NPI:1992037584
Name:LOCH, MALLORY (DPT)
Entity Type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:LOCH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 W. 31ST STREET
Mailing Address - Street 2:SPORTS AND ORTHO
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60616
Mailing Address - Country:US
Mailing Address - Phone:312-225-3119
Mailing Address - Fax:312-225-3219
Practice Address - Street 1:10909 S. WESTERN AVENUE
Practice Address - Street 2:SPORTS AND ORTHO
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643
Practice Address - Country:US
Practice Address - Phone:773-779-7970
Practice Address - Fax:773-779-7969
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-05
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist