Provider Demographics
NPI:1912324518
Name:MALOOF, MARY (PT)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:MALOOF
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:DINAPOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:4153 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-2854
Mailing Address - Country:US
Mailing Address - Phone:770-931-8686
Mailing Address - Fax:770-931-0462
Practice Address - Street 1:4153 LAWRENCEVILLE HWY NW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-2854
Practice Address - Country:US
Practice Address - Phone:770-931-8686
Practice Address - Fax:770-931-0462
Is Sole Proprietor?:No
Enumeration Date:2014-03-21
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001750225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist