Healthcare Provider Details

I. General information

NPI: 1356214761
Provider Name (Legal Business Name): ANN MALLORY PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2025
Last Update Date: 09/24/2025
Certification Date: 09/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4733 CHABOT DR STE 203
PLEASANTON CA
94588-3972
US

IV. Provider business mailing address

4733 CHABOT DR STE 203
PLEASANTON CA
94588-3972
US

V. Phone/Fax

Practice location:
  • Phone: 408-559-9020
  • Fax: 408-559-9020
Mailing address:
  • Phone: 408-559-9020
  • Fax: 408-559-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberAT4119
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: