Provider Demographics
NPI:1104656370
Name:MALONEY, MARTIN R (PT)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:R
Last Name:MALONEY
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 WAYNE RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1183
Mailing Address - Country:US
Mailing Address - Phone:814-661-3790
Mailing Address - Fax:
Practice Address - Street 1:1100 W LONG AVE
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3986
Practice Address - Country:US
Practice Address - Phone:814-371-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADAPT000918225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist