Provider Demographics
NPI:1518185545
Name:MALETA, MADALITSO LISA (PT)
Entity Type:Individual
Prefix:MS
First Name:MADALITSO
Middle Name:LISA
Last Name:MALETA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 LOCH NESS CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7806
Mailing Address - Country:US
Mailing Address - Phone:240-723-0566
Mailing Address - Fax:
Practice Address - Street 1:ADVENTIST HOME HEALTH SERVICES INC
Practice Address - Street 2:12041 BOURNEFIELD WAY SUITE B
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7908
Practice Address - Country:US
Practice Address - Phone:301-592-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25864225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist