Provider Demographics
NPI:1811095649
Name:MALLINI, KERRY CRONIN (PT, NCS)
Entity type:Individual
Prefix:MRS
First Name:KERRY
Middle Name:CRONIN
Last Name:MALLINI
Suffix:
Gender:F
Credentials:PT, NCS
Other - Prefix:MS
Other - First Name:KERRY
Other - Middle Name:MICHELE
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10550 BAYMEADOWS RD
Mailing Address - Street 2:UNIT 224
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4518
Mailing Address - Country:US
Mailing Address - Phone:904-537-0358
Mailing Address - Fax:
Practice Address - Street 1:3901 UNIVERSITY BLVD S
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4312
Practice Address - Country:US
Practice Address - Phone:904-858-7200
Practice Address - Fax:904-858-7240
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT21048225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAB037ZMedicare PIN