Active NPI
Jeffrey Donald Mallory, MSPT
- Physical Therapist
- Rolla, MO
National Provider Identifier
1720319148
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 112290
- Practice address
- 1200 McCutchen Rd
Rolla, MO 65401-2615 - Phone
- (573) 364-2311
- NPI assigned
- Jan 25, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 112290 | MO | Primary |
Addresses
Primary practice location
1200 McCutchen Rd
Rolla, MO 65401-2615
Mailing address
1100 Grandsir Ave
Rolla, MO 65401-3523
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 112290 | MO | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1264377600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1264377600000",
"number": "1720319148",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 GRANDSIR AVE",
"city": "ROLLA",
"state": "MO",
"postal_code": "654013523"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 MCCUTCHEN RD",
"city": "ROLLA",
"state": "MO",
"postal_code": "654012615",
"telephone_number": "573-364-2311"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "JEFFREY",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"credential": "MSPT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-01-25",
"last_updated": "2010-01-25",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MO",
"license": "112290",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rolla, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.