Provider Demographics
NPI:1033159926
Name:MALONE, CARY G (PT DPT)
Entity Type:Individual
Prefix:
First Name:CARY
Middle Name:G
Last Name:MALONE
Suffix:
Gender:M
Credentials:PT DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 MARVIN HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:TX
Mailing Address - Zip Code:75951-3479
Mailing Address - Country:US
Mailing Address - Phone:409-384-7041
Mailing Address - Fax:409-384-7064
Practice Address - Street 1:296 MARVIN HANCOCK DR
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TX
Practice Address - Zip Code:75951-3479
Practice Address - Country:US
Practice Address - Phone:409-384-7041
Practice Address - Fax:409-384-7064
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1133130225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2018OtherBLUE CROSS & BLUE SHIELD
TX8B5506Medicare ID - Type Unspecified