Provider Demographics
NPI:1487062550
Name:LLANAS, MALLORIE (MS, LAT, ATC, CES)
Entity type:Individual
Prefix:MS
First Name:MALLORIE
Middle Name:
Last Name:LLANAS
Suffix:
Gender:F
Credentials:MS, LAT, ATC, CES
Other - Prefix:
Other - First Name:MALLORIE
Other - Middle Name:
Other - Last Name:EASLICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 CRISANTO AVE STE B
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-6272
Mailing Address - Country:US
Mailing Address - Phone:803-548-6464
Mailing Address - Fax:
Practice Address - Street 1:130 CRISANTO AVE STE B
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-6272
Practice Address - Country:US
Practice Address - Phone:803-548-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLAT-26342255A2300X
SC15702255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer