Provider Demographics
NPI:1376127795
Name:VOTAW, MALACHI (PT, DPT)
Entity Type:Individual
Prefix:
First Name:MALACHI
Middle Name:
Last Name:VOTAW
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 1:1370 FRIENDS WAY
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-4213
Mailing Address - Country:US
Mailing Address - Phone:503-332-6417
Mailing Address - Fax:
Practice Address - Street 1:457 N ELM ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3001
Practice Address - Country:US
Practice Address - Phone:760-489-1969
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-11
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA300167225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist