Provider Demographics
NPI:1700869732
Name:MALLERS & SWOVERLAND ORTHOPAEDIC PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MALLERS & SWOVERLAND ORTHOPAEDIC PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:MALLERS
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:260-489-9887
Mailing Address - Street 1:9602 COLDWATER RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2095
Mailing Address - Country:US
Mailing Address - Phone:260-489-9887
Mailing Address - Fax:260-489-9121
Practice Address - Street 1:9602 COLDWATER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2095
Practice Address - Country:US
Practice Address - Phone:260-489-9887
Practice Address - Fax:260-489-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCJ8713OtherRR MEDICARE
IN200373620AMedicaid
IN188320Medicare PIN
INCJ8713OtherRR MEDICARE