Healthcare Provider Details

I. General information

NPI: 1770984940
Provider Name (Legal Business Name): MALLORY ZAPPITELLI ATC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 09/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1162 EDEN TERRACE
ROCK HILL SC
29730
US

IV. Provider business mailing address

1840 GINGERCAKE CIR APARTMENT 104
ROCK HILL SC
29732-7416
US

V. Phone/Fax

Practice location:
  • Phone: 440-668-2438
  • Fax:
Mailing address:
  • Phone: 440-668-2438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number1448
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: