Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | PT010387 | GA |
NPI | 1003197310 |
---|---|
Provider Name | Dr. Brian Joseph Maloney |
First Address | Lawrenceville, GA 30046-8761 |
Second Address | Lawrenceville, GA 30046-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2011 |
Last Update Date | 31/08/2011 |