Provider Demographics
NPI:1962720474
Name:MALAN, BRAXTON LELIA (PTA)
Entity type:Individual
Prefix:MRS
First Name:BRAXTON
Middle Name:LELIA
Last Name:MALAN
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:37 SUNFIRE AVE
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011-1019
Mailing Address - Country:US
Mailing Address - Phone:717-731-5442
Mailing Address - Fax:
Practice Address - Street 1:6 S MADDER DR
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17050-7954
Practice Address - Country:US
Practice Address - Phone:717-620-8109
Practice Address - Fax:717-918-2020
Is Sole Proprietor?:No
Enumeration Date:2010-05-07
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE1001267225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant