Provider Demographics
NPI:1700239233
Name:MALONEE, ANGIE (DOCTOR OF PHYSICAL T)
Entity Type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:MALONEE
Suffix:
Gender:F
Credentials:DOCTOR OF PHYSICAL T
Other - Prefix:DR
Other - First Name:ANGIE
Other - Middle Name:
Other - Last Name:MALONEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPT
Mailing Address - Street 1:3848 HARROW DR
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23831-7145
Mailing Address - Country:US
Mailing Address - Phone:804-524-0533
Mailing Address - Fax:804-524-0133
Practice Address - Street 1:3848 HARROW DR
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-7145
Practice Address - Country:US
Practice Address - Phone:434-955-0177
Practice Address - Fax:804-524-0133
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305204813225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2305204813Medicare NSC