Provider Demographics
NPI:1558900175
Name:MALANOWSKI, ROBIN (PT)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:MALANOWSKI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:MOLDENHAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:1539 W ROCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-5442
Mailing Address - Country:US
Mailing Address - Phone:602-799-2341
Mailing Address - Fax:
Practice Address - Street 1:245 E BELL RD STE 58
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85022-6318
Practice Address - Country:US
Practice Address - Phone:602-843-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPT-31062225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist