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NPI Code Detail

MEDICARE: MALLORY KRAFT

MEDICARE: MALLORY KRAFT
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
1225100000XPhysical Therapist09743LA

General Provider Information

NPI Number : 1417472416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY KRAFT
Provider Business Mailing Address
First Line : 132 S 6TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-3317
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 132 S 6TH ST
Second Line :
City : PONCHATOULA
State : LA
Zip : 70454-3317
Country : US
Telephone Number : 985-386-6884
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2017
Last Update Date : 08/10/2017

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Directions to “ MALLORY KRAFT ” Practice Location

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