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General NPI Number Information
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NPI Number | 1790292936
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Entity Type | Organization
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Legal Business Name | ANDREW MALLON PT LLC
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Dates
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Enumeration Date | 01/09/2018
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Last Update Date | 01/09/2018
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Provider Practice Location Address
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Address Line | 931 ROUTE 73 S STE 5A
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City | MARLTON
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State | NJ
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Zip | 08053-9641
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Country | US
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Telephone | 856-237-4703
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Fax |
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Provider Business Mailing Address
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Address Line | 273 FRONT ST
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City | ATCO
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State | NJ
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Zip | 08004-1958
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICAL THERAPIST
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Name | ANDREW MALLON
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Credential | PT, DPT, ATC, CSCS
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Telephone | 856-237-4703
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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