Provider Demographics
NPI:1487750642
Name:MALONE, MARK STEPHEN (PT MT)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:STEPHEN
Last Name:MALONE
Suffix:
Gender:M
Credentials:PT MT
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Mailing Address - Street 1:12952 BANDERA RD STE 107
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4733
Mailing Address - Country:US
Mailing Address - Phone:830-315-8420
Mailing Address - Fax:830-315-8500
Practice Address - Street 1:1412 SIDNEY BAKER ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-2725
Practice Address - Country:US
Practice Address - Phone:830-315-8420
Practice Address - Fax:830-315-8500
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2024-08-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX1164493225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T5381OtherBCBS PROVIDER #
TX8G9144Medicare PIN