Provider Demographics
NPI:1336936285
Name:MALCZEWSKI, REILY (DPT)
Entity type:Individual
Prefix:
First Name:REILY
Middle Name:
Last Name:MALCZEWSKI
Suffix:
Gender:
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:PO BOX 6526
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29260-6526
Mailing Address - Country:US
Mailing Address - Phone:803-693-5040
Mailing Address - Fax:
Practice Address - Street 1:610 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4302
Practice Address - Country:US
Practice Address - Phone:843-407-0377
Practice Address - Fax:843-799-1944
Is Sole Proprietor?:No
Enumeration Date:2025-04-23
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12675225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist