Provider Demographics
NPI:1699506949
Name:MALAGISI, JARED MICHAEL
Entity type:Individual
Prefix:
First Name:JARED
Middle Name:MICHAEL
Last Name:MALAGISI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 BRIGHTON BAY BLVD NE APT 8105
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33716-3497
Mailing Address - Country:US
Mailing Address - Phone:518-775-3929
Mailing Address - Fax:
Practice Address - Street 1:11224 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-4752
Practice Address - Country:US
Practice Address - Phone:727-394-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-09
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT41643225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist