Provider Demographics
NPI:1154790715
Name:MALASKI, KAITLYN MARIE (DPT, NCS)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:MARIE
Last Name:MALASKI
Suffix:
Gender:F
Credentials:DPT, NCS
Other - Prefix:
Other - First Name:KAITLYN
Other - Middle Name:MARIE
Other - Last Name:MEERNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 VETERANS DR STE 2
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4582
Mailing Address - Country:US
Mailing Address - Phone:231-463-0754
Mailing Address - Fax:231-252-4634
Practice Address - Street 1:3600 VETERANS DR STE 2
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4582
Practice Address - Country:US
Practice Address - Phone:231-463-0754
Practice Address - Fax:231-252-4634
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501016323225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist