Basic Information
| Provider Information | |||||||||
| NPI: | 1336540541 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALLARD | ||||||||
| FirstName: | ALAINA | ||||||||
| MiddleName: | COPE | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 32569 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379302569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8656947725 | ||||||||
| FaxNumber: | 8655608551 | ||||||||
| Practice Location | |||||||||
| Address1: | 9430 PARK WEST BLVD STE 230 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8655608550 | ||||||||
| FaxNumber: | 8655608551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2014 | ||||||||
| LastUpdateDate: | 09/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 9570 | TN | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | Q031525 | 05 | TN | MEDICAID | 9570 | 01 | TN | STATE PT LICENSE | OTHER |