Provider Demographics
NPI:1558522359
Name:MALOUFF, DANIEL LEE JR (PT)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:LEE
Last Name:MALOUFF
Suffix:JR
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 1:95 WEST FIRST STREET
Mailing Address - Street 2:
Mailing Address - City:MONTE VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81144-1070
Mailing Address - Country:US
Mailing Address - Phone:719-852-7081
Mailing Address - Fax:719-587-1543
Practice Address - Street 1:95 WEST FIRST STREET
Practice Address - Street 2:
Practice Address - City:MONTE VISTA
Practice Address - State:CO
Practice Address - Zip Code:81144-1070
Practice Address - Country:US
Practice Address - Phone:719-852-7081
Practice Address - Fax:719-587-1543
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10011225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10011OtherSTATE LICENCE