Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | 429-19 | WI |
NPI | 1003435462 |
---|---|
Provider Name | Leslie Ann Malavsky |
First Address | Muskego, WI 53150-0328 |
Second Address | Muskego, WI 53150-7742 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2020 |
Last Update Date | 15/04/2020 |