Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251P0200X | Physical Therapist - Pediatrics | 1168746 | TX |
Y | 2251P0200X | Physical Therapist - Pediatrics | 8142501-2401 | UT |
N | 2251S0007X | Physical Therapist - Sports | 1168746 | TX |
NPI | 1164605168 |
---|---|
Provider Name | Lauren Whitehouse Malik |
First Address | Ogden, UT 84403-2314 |
Second Address | Ogden, UT 84403-2314 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/12/2007 |
Last Update Date | 30/01/2012 |