Healthcare Provider Details

I. General information

NPI: 1326427584
Provider Name (Legal Business Name): MALLORY SCHWEITZER DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/18/2020
Certification Date: 05/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 SUNRISE BLVD E STE 203
PUYALLUP WA
98374-8847
US

IV. Provider business mailing address

11212 SUNRISE BLVD E STE 203
PUYALLUP WA
98374-8847
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-4262
  • Fax: 844-896-4953
Mailing address:
  • Phone: 253-841-4262
  • Fax: 844-896-4953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO60977510
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPO60977510
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code213ER0200X
TaxonomyRadiology Podiatrist
License NumberPO60977510
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO60977510
License Number StateWA
# 5
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO60977510
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: