Provider Demographics
NPI:1467167353
Name:BRUDVIK, MALIA (MS, ATC, LAT, CSCS)
Entity Type:Individual
Prefix:MS
First Name:MALIA
Middle Name:
Last Name:BRUDVIK
Suffix:
Gender:F
Credentials:MS, ATC, LAT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7168 W VINERIDGE DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85757-0154
Mailing Address - Country:US
Mailing Address - Phone:253-736-3554
Mailing Address - Fax:
Practice Address - Street 1:350 W SAHUARITA RD BLDG 10
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9000
Practice Address - Country:US
Practice Address - Phone:520-625-3502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2024-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZATR-0095312255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program