Provider Demographics
NPI:1649497249
Name:MALLARI, MARILYN (LPT)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:MALLARI
Suffix:
Gender:F
Credentials:LPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2457 SHELLEY LANE
Mailing Address - Street 2:
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109
Mailing Address - Country:US
Mailing Address - Phone:856-662-1141
Mailing Address - Fax:
Practice Address - Street 1:2457 SHELLEY LN
Practice Address - Street 2:
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-3210
Practice Address - Country:US
Practice Address - Phone:856-662-1141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT009085L2251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics