Provider Demographics
NPI:1093582645
Name:MALMQUIST, CARL IV
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:MALMQUIST
Suffix:IV
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:991 FORSYTHIA LN
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-7360
Mailing Address - Country:US
Mailing Address - Phone:928-581-9810
Mailing Address - Fax:
Practice Address - Street 1:392 GARRISONVILLE RD STE 211
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1500
Practice Address - Country:US
Practice Address - Phone:540-602-4277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305216263225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist