Provider Demographics
NPI:1235298001
Name:MALMQUIST, CARL YALE III (MSPT)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:YALE
Last Name:MALMQUIST
Suffix:III
Gender:M
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6319 E TELEGRAPH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1117
Mailing Address - Country:US
Mailing Address - Phone:928-920-6600
Mailing Address - Fax:877-544-6468
Practice Address - Street 1:6319 E TELEGRAPH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1117
Practice Address - Country:US
Practice Address - Phone:928-920-6600
Practice Address - Fax:877-544-6468
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6056225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0920400OtherNON-CONTRACTED ID NUMBER