Provider Demographics
NPI:1124329149
Name:MALVINO, LARAINE (DPT)
Entity type:Individual
Prefix:DR
First Name:LARAINE
Middle Name:
Last Name:MALVINO
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:368 LAKEHURST RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-7339
Mailing Address - Country:US
Mailing Address - Phone:732-914-8500
Mailing Address - Fax:732-914-8505
Practice Address - Street 1:368 LAKEHURST RD
Practice Address - Street 2:SUITE 202
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-7339
Practice Address - Country:US
Practice Address - Phone:732-914-8500
Practice Address - Fax:732-914-8505
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01367100225100000X
NY024687225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist