Provider Demographics
NPI:1497128508
Name:MALO SPORTS REHABILITATION AND PHYSICAL THERAPY INC.
Entity Type:Organization
Organization Name:MALO SPORTS REHABILITATION AND PHYSICAL THERAPY INC.
Other - Org Name:SPORTS, HAND, ARM REHABILITATION CENTER PHYSICAL THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/C.E.O.
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MALO
Authorized Official - Suffix:
Authorized Official - Credentials:DPT
Authorized Official - Phone:559-435-7472
Mailing Address - Street 1:464 BLISS AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0601
Mailing Address - Country:US
Mailing Address - Phone:559-435-7472
Mailing Address - Fax:559-570-0900
Practice Address - Street 1:7721 N 1ST ST
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-0962
Practice Address - Country:US
Practice Address - Phone:559-435-7472
Practice Address - Fax:559-570-0900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-11
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38220261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy