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NPI Code Detail

MEDICARE: DR. MALLERY CATHERINE AIKEN PT, DPT

MEDICARE: DR. MALLERY CATHERINE AIKEN PT, DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12251P0200XPediatric Physical TherapistPT014500GA

General Provider Information

NPI Number : 1306479480
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MALLERY CATHERINE AIKEN PT, DPT
Provider Business Mailing Address
First Line : 790 REMINGTON BLVD
Second Line :
City : BOLINGBROOK
State : IL
Zip : 60440-4909
Country : US
Telephone Number : 866-370-8206
Fax Number : 517-435-3670
Provider Business Practice Location Address
First Line : 5977 E GRANT RD STE 101
Second Line :
City : TUCSON
State : AZ
Zip : 85712-2369
Country : US
Telephone Number : 520-822-8640
Fax Number : 520-822-8641
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/18/2020
Last Update Date : 12/08/2022

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