Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251P0200X | Physical Therapist - Pediatrics | 8160 | AZ |
NPI | 1124284955 |
---|---|
Provider Name | Michelle Lynn Malec |
First Address | Phoenix, AZ 85016-7146 |
Second Address | Phoenix, AZ 85016-7146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/07/2008 |
Last Update Date | 31/07/2008 |