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NPI Code Detail

MEDICARE: MALLORY BLANCK

MEDICARE: MALLORY BLANCK
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 Therapist05011189AIN

General Provider Information

NPI Number : 1588511869
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY BLANCK
Provider Business Mailing Address
First Line : 4638 KINTZ DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46239-9046
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7510 ROSEGATE DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46237-8301
Country : US
Telephone Number : 317-889-9300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2026
Last Update Date : 03/14/2026

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Directions to “ MALLORY BLANCK ” Practice Location

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