Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | 2171PT | MT |
Y | 2251N0400X | Physical Therapist - Neurology | 0012895 | CO |
NPI | 1477703049 |
---|---|
Provider Name | Mrs. Jessica Katherine Malouf |
First Address | Fort Collins, CO 80526-1849 |
Second Address | Fort Collins, CO 80526-1849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/09/2008 |
Last Update Date | 04/04/2016 |