Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 7322 | MA |
N | 2251S0007X | Physical Therapist - Sports | 7322 | MA |
N | 2251X0800X | Physical Therapist - Orthopedic | 7322 | MA |
NPI | 1407318272 |
---|---|
Provider Name | Sandra Thelma Malek |
First Address | N Dartmouth, MA 02747-1333 |
Second Address | New Bedford, MA 02745 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2019 |
Last Update Date | 02/04/2019 |