Provider Demographics
NPI:1427132893
Name:MALONE, TRICIA LYNN (PT)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:LYNN
Last Name:MALONE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:LYNN
Other - Last Name:MCDANIEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:489 WASHINGTON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUBURN
Mailing Address - State:MA
Mailing Address - Zip Code:01501-5709
Mailing Address - Country:US
Mailing Address - Phone:508-721-0000
Mailing Address - Fax:508-721-0100
Practice Address - Street 1:489 WASHINGTON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUBURN
Practice Address - State:MA
Practice Address - Zip Code:01501-5709
Practice Address - Country:US
Practice Address - Phone:508-721-0000
Practice Address - Fax:508-721-0100
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 303952251X0800X
MA18973225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA171680700OtherUS DEPT OF LABOR
CAZZZ59255ZOtherBLUE SHIELD
CAZZZ59255ZOtherBLUE SHIELD
CA680397878OtherTIN