Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251X0800X | Physical Therapist - Orthopedic | 006811 | KY |
NPI | 1043671035 |
---|---|
Provider Name | Dr. Corey Malone |
First Address | Louisville, KY 40220-1622 |
Second Address | Louisville, KY 40220-1622 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/03/2016 |
Last Update Date | 17/03/2016 |