Provider Demographics
NPI:1891534632
Name:COLL, MALLORIE
Entity type:Individual
Prefix:
First Name:MALLORIE
Middle Name:
Last Name:COLL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 175
Mailing Address - Street 2:
Mailing Address - City:TWIN ROCKS
Mailing Address - State:PA
Mailing Address - Zip Code:15960-0175
Mailing Address - Country:US
Mailing Address - Phone:814-540-5636
Mailing Address - Fax:
Practice Address - Street 1:320 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1601
Practice Address - Country:US
Practice Address - Phone:814-534-7360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAYM018199227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered