Provider Demographics
NPI:1831502939
Name:MALONE, ANNA (ATC, LAT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MALONE
Suffix:
Gender:F
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 WOODS ISLAND CIR
Mailing Address - Street 2:APT 203
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-1469
Mailing Address - Country:US
Mailing Address - Phone:704-441-9454
Mailing Address - Fax:
Practice Address - Street 1:2875 NW GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3552
Practice Address - Country:US
Practice Address - Phone:772-232-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-05
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL34062255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer