Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225200000X | Physical Therapy Assistant | AT1709 | CA |
NPI | 1003463837 |
---|---|
Provider Name | Marilyn Malone |
First Address | Richmond, CA 94804-1323 |
Second Address | Oakland, CA 94619-1807 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2019 |
Last Update Date | 26/08/2019 |