Provider Demographics
NPI:1053861666
Name:MALY, MICAH JAMES (DPT)
Entity Type:Individual
Prefix:DR
First Name:MICAH
Middle Name:JAMES
Last Name:MALY
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 GRAND MARKET AVE
Mailing Address - Street 2:
Mailing Address - City:BERTHOUD
Mailing Address - State:CO
Mailing Address - Zip Code:80513-2710
Mailing Address - Country:US
Mailing Address - Phone:970-290-5708
Mailing Address - Fax:
Practice Address - Street 1:730 14TH ST SW
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-6349
Practice Address - Country:US
Practice Address - Phone:970-663-0815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61816225100000X
CO0013435225100000X, 2251X0800X
WV003501225100000X
TN0000010852225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist