Provider Demographics
NPI:1215764022
Name:STREHL, MALORY ROSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:MALORY
Middle Name:ROSE
Last Name:STREHL
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3229 W MONTAGUE AVE UNIT 3221
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-7944
Mailing Address - Country:US
Mailing Address - Phone:262-290-1090
Mailing Address - Fax:
Practice Address - Street 1:204 BRIGHTON PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-3005
Practice Address - Country:US
Practice Address - Phone:843-261-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12507225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist