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General NPI Number Information
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NPI Number | 1245993278
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Entity Type | Individual
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Provider Name | MALLORY SONENTHAL PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 10/17/2021
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Last Update Date | 10/17/2021
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Provider Practice Location Address
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Address Line | 710 S PAULINA ST
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City | CHICAGO
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State | IL
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Zip | 60612-3808
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Country | US
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Telephone | 312-942-2791
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 RAVINE LN
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-3346
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Country | US
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Telephone | 847-266-7531
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070.025874
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License Number State | IL
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