Healthcare Provider Details

I. General information

NPI: 1689916181
Provider Name (Legal Business Name): MALLORY LEIGH MCFARLANE PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALLORY LEIGH SPENCER PT, DPT

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 N 300 W STE 211
PROVO UT
84604-6124
US

IV. Provider business mailing address

PO BOX 25537
SALT LAKE CITY UT
84125-0537
US

V. Phone/Fax

Practice location:
  • Phone: 801-357-1250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number9331370-2401
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number070.019816
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9331370-2401
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: