Provider Demographics
NPI:1689916181
Name:MCFARLANE, MALLORY LEIGH (PT, DPT)
Entity type:Individual
Prefix:MRS
First Name:MALLORY
Middle Name:LEIGH
Last Name:MCFARLANE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:MS
Other - First Name:MALLORY
Other - Middle Name:LEIGH
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PT, DPT
Mailing Address - Street 1:PO BOX 25537
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0537
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1157 N 300 W STE 211
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-6124
Practice Address - Country:US
Practice Address - Phone:801-357-1250
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-22
Last Update Date:2025-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9331370-24012251X0800X, 225100000X
IL070.0198162251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA004733OtherIOWA STATE LICENSE
IL070.019816OtherSTATE OF ILLINOIS PHYSICAL THERAPY LICENSE
UT9331370-2401OtherUTAH PT LICENSE