Provider Demographics
NPI:1871834077
Name:MEISSNER, MALORY J (PTA)
Entity type:Individual
Prefix:
First Name:MALORY
Middle Name:J
Last Name:MEISSNER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 LINKS BLVD
Mailing Address - Street 2:APT 3903
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-4871
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3835 WATERMELON RD
Practice Address - Street 2:STE E
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-5001
Practice Address - Country:US
Practice Address - Phone:205-759-2211
Practice Address - Fax:205-759-2213
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALPTA6515225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant