MEDICARE: MALLORY HAMM PT

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	225100000X	Physical Therapist	PT018882	PA

General Provider Information

NPI Number	:	1730329087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALLORY HAMM PT

Provider Business Mailing Address
First Line	:	81 FISH RD
Second Line	:
City	:	WELLSBORO
State	:	PA
Zip	:	16901-6913
Country	:	US
Telephone Number	:	610-914-3884
Fax Number	:

Provider Business Practice Location Address
First Line	:	416 S MAIN ST
Second Line	:
City	:	MANSFIELD
State	:	PA
Zip	:	16933-1510
Country	:	US
Telephone Number	:	570-662-1900
Fax Number	:

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

Provider Enumeration Date	:	02/26/2009
Last Update Date	:	03/17/2018

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Directions to “ MALLORY HAMM PT” Practice Location

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