MEDICARE: MALLORY COOK PTA

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
1	225200000X	Physical Therapy Assistant	06006844A	IN

General Provider Information

NPI Number	:	1568345460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY COOK PTA

Provider Business Mailing Address
First Line	:	715 N MILL ST
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1834
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	715 N MILL ST
Second Line	:
City	:	HARTFORD CITY
State	:	IN
Zip	:	47348-1834
Country	:	US
Telephone Number	:	765-348-2273
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2025
Last Update Date	:	07/28/2025

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Directions to “ MALLORY COOK PTA” Practice Location

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