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General NPI Number Information
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NPI Number | 1669910097
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Entity Type | Individual
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Provider Name | MALLORY LYNN REIBER ATC, PTA
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Gender | Female
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Dates
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Enumeration Date | 02/06/2017
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Last Update Date | 08/12/2025
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Provider Practice Location Address
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Address Line | 1051 W SOUTH ST
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City | KEWANEE
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State | IL
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Zip | 61443-8354
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Country | US
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Telephone | 217-871-9181
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Fax |
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Provider Business Mailing Address
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Address Line | 822 PULASKI ST
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City | LINCOLN
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State | IL
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Zip | 62656-2902
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Country | US
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Telephone | 217-871-9181
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 096004692
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 160009119
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License Number State | IL
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