Provider Demographics
NPI:1225570849
Name:MALOOLY, MARY CLAIRE (PT, DPT, ATC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CLAIRE
Last Name:MALOOLY
Suffix:
Gender:F
Credentials:PT, DPT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 SANDPOINTE AVE
Mailing Address - Street 2:STE 130
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707-5785
Mailing Address - Country:US
Mailing Address - Phone:626-298-1968
Mailing Address - Fax:
Practice Address - Street 1:30230 RANCHO VIEJO RD STE 120
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-1569
Practice Address - Country:US
Practice Address - Phone:949-461-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA292278225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist