Provider Demographics
NPI:1154587327
Name:FRANKLIN, MALLORY (PT)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:
Last Name:FRANKLIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 PATRICIA M. GENOVA DRIVE
Mailing Address - Street 2:EASTERN REHABILITATION NETWORK 5TH FLOOR
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111
Mailing Address - Country:US
Mailing Address - Phone:860-667-5480
Mailing Address - Fax:860-667-8416
Practice Address - Street 1:252 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042
Practice Address - Country:US
Practice Address - Phone:860-643-3562
Practice Address - Fax:860-643-3565
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008365225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist