Healthcare Provider Details

I. General information

NPI: 1821903212
Provider Name (Legal Business Name): MALLORY WADE CORLEY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2690 VIA DE LA VALLE # D-160
DEL MAR CA
92014-1970
US

IV. Provider business mailing address

936 LUNA VISTA DR
ESCONDIDO CA
92025-5277
US

V. Phone/Fax

Practice location:
  • Phone: 858-290-0855
  • Fax:
Mailing address:
  • Phone: 760-274-7292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: