Mallory J Willis, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

PTL0016942 Issued in CO

Practice address

600 S 21St St Unit 130
Colorado Springs, CO 80904-3763

Phone

(719) 634-1110

Fax

(719) 634-1112

NPI assigned

May 18, 2020

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Mallory J Weiss Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peak Pelvic Health

  • Physical Therapist
  • Colorado Springs, CO
  • NPI 1487370144
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1589760000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1457974008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 S 21ST ST UNIT 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043763",
            "telephone_number": "719-634-1110",
            "fax_number": "719-634-1112"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S 21ST ST UNIT 130",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809043763",
            "telephone_number": "719-634-1110",
            "fax_number": "719-634-1112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIS",
        "first_name": "MALLORY",
        "middle_name": "J",
        "name_prefix": "Mrs.",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-18",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "CO",
            "license": "PTL0016942",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALLORY",
            "last_name": "WEISS",
            "middle_name": "J",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ashley Willis
• Cathy E Willis, LMFT
• Gordya Willis
• Judson Willis, LPC
• Luke William Willis, IDMT
• Schuyler Elizabeth Willis, MA, LPC
• Diane Cheryl Williston, DPT
• Eric Williston, DPT
• Bertram Willman, MD
• Willow and Courage Counseling, LLC

• Physical Therapist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Physical Therapist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.