Provider Demographics
NPI:1457485385
Name:MALINCHAK, CAROLINE BLANCHE (PHYSICAL THERAPY AST)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:BLANCHE
Last Name:MALINCHAK
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY AST
Other - Prefix:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:RR 2 BOX 221H
Mailing Address - Street 2:
Mailing Address - City:KINGSLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18826-9502
Mailing Address - Country:US
Mailing Address - Phone:570-278-1366
Mailing Address - Fax:
Practice Address - Street 1:10 HART PL
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1593
Practice Address - Country:US
Practice Address - Phone:570-282-5264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATE000928L225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant