Crockett, Mallori

Crockett, Mallori is an individual health care provider with primary practice located at 801 6Th Ave Box 870308, Tuscaloosa AL 35487-1409. She recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer is her primary health care specialty. Crockett, Mallori can be contacted via phone (205) 348-5832.

Contact Information

Primary practice address
801 6Th Ave Box 870308 Tuscaloosa AL 35487-1409
Phone: (205) 348-5832
Fax: (205) 348-9770
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Physical Medicine & Rehabilitation 208100000X 1537 Alabama
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X 1537 Alabama

Profile Details

NPI number 1255738837
LBN Legal business name Crockett, Mallori
Credentials Athletic Trainer, Certified (ATC)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 26th, 2014
Last updated Dec 22nd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1255738837 NPPES
Other 2000003186 BOC #
Other 1537 BOC #

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