Provider Demographics
NPI:1962899609
Name:MALIK, KATHERINE ANNE
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANNE
Last Name:MALIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 LAKE HOLLINGSWORTH DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-5607
Mailing Address - Country:US
Mailing Address - Phone:863-680-4267
Mailing Address - Fax:
Practice Address - Street 1:15 MOUNT PELIA RD
Practice Address - Street 2:1022 ELAM CENTER
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3313
Practice Address - Country:US
Practice Address - Phone:731-881-7679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
TN12412255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer