Provider Demographics
NPI:1679884464
Name:MALAVER-REYES, MARIA C (PT)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:MALAVER-REYES
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:360 COLERAINE PL
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-5571
Mailing Address - Country:US
Mailing Address - Phone:770-569-0320
Mailing Address - Fax:855-232-8604
Practice Address - Street 1:11350 WOODSTOCK RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-7541
Practice Address - Country:US
Practice Address - Phone:770-569-0320
Practice Address - Fax:855-232-8604
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003504225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist