Provider Demographics
NPI:1710086962
Name:MALYS PHYSICAL THERAPY
Entity Type:Organization
Organization Name:MALYS PHYSICAL THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MALYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-253-6891
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1941
Mailing Address - Country:US
Mailing Address - Phone:315-253-6891
Mailing Address - Fax:315-255-0873
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 130
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1941
Practice Address - Country:US
Practice Address - Phone:315-253-6891
Practice Address - Fax:315-255-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0555600001Medicare NSC
NYAA0487Medicare PIN