Provider Demographics
NPI:1184004764
Name:MALEKI, SAMIR (PT, DPT)
Entity Type:Individual
Prefix:
First Name:SAMIR
Middle Name:
Last Name:MALEKI
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 1:616 BILLY SUNDAY RD
Mailing Address - Street 2:UNIT 119
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8050
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1902 S CENTER ST
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-5983
Practice Address - Country:US
Practice Address - Phone:641-754-6120
Practice Address - Fax:641-754-5019
Is Sole Proprietor?:No
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078560225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist