Provider Demographics
NPI:1073522439
Name:MALONE, ERIC S (PT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:S
Last Name:MALONE
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 8TH AVE NE STE 320
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-5436
Mailing Address - Country:US
Mailing Address - Phone:425-462-5006
Mailing Address - Fax:425-462-5019
Practice Address - Street 1:3101 NORTHUP WAY STE 101
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-1469
Practice Address - Country:US
Practice Address - Phone:425-462-5006
Practice Address - Fax:425-462-5019
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00006834225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2127666Medicaid
WAS84469Medicare UPIN