Provider Demographics
NPI:1417202482
Name:MALIN, DAVID (PT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:MALIN
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 1:550 REDCLIFF CIR UNIT 202
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-9242
Mailing Address - Country:US
Mailing Address - Phone:970-309-7202
Mailing Address - Fax:
Practice Address - Street 1:550 REDCLIFF CIR UNIT 202
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432-9242
Practice Address - Country:US
Practice Address - Phone:970-309-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2355225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist