Healthcare Provider Details

I. General information

NPI: 1194358937
Provider Name (Legal Business Name): MALLORY MCKAY ROSE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2020
Last Update Date: 02/20/2020
Certification Date: 02/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7191 CAHABA VALLEY ROAD
BRIMINGHAM AL
35242
US

IV. Provider business mailing address

7191 CAHABA VALLEY ROAD
BRIMINGHAM AL
35242
US

V. Phone/Fax

Practice location:
  • Phone: 205-408-6600
  • Fax: 205-408-6459
Mailing address:
  • Phone: 205-408-6600
  • Fax: 205-408-6459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPTH9731
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: