Provider Demographics
NPI:1982172466
Name:NEW, MALLORY MORIN (PT, DPT)
Entity type:Individual
Prefix:
First Name:MALLORY
Middle Name:MORIN
Last Name:NEW
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 1:5111 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5214
Mailing Address - Country:US
Mailing Address - Phone:912-239-6140
Mailing Address - Fax:912-335-3539
Practice Address - Street 1:5111 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5214
Practice Address - Country:US
Practice Address - Phone:912-239-6140
Practice Address - Fax:912-335-3539
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-02
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT013752225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty