Van De Graff, Mallory

Van De Graff, Mallory is an individual health care provider with primary practice located at 1952 E 7000 S , Salt Lake City UT 84121-6877. She recently has only one registered license in Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant, which is considered as her primary health care specialty. Van De Graff, Mallory can be contacted via phone (801) 942-3311.

Contact Information

Primary practice address
1952 E 7000 S Salt Lake City UT 84121-6877
Phone: (801) 942-3311
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Physical Therapy Assistant 225200000X

Profile Details

NPI number 1124652193
LBN Legal business name Van De Graff, Mallory
Credentials Physical Therapist Assistant (PTA)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 27th, 2020
Last updated Feb 27th, 2020 - 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 1124652193 NPPES
Utah Other 110977728019 PTA LICENSE

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