Provider Demographics
NPI:1720389539
Name:GOOD-MALLOY, GENEVIEVE OLDS (DPT)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:OLDS
Last Name:GOOD-MALLOY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6707 DEMOCRACY BLVD STE 504
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-1166
Mailing Address - Country:US
Mailing Address - Phone:301-637-8712
Mailing Address - Fax:410-290-4488
Practice Address - Street 1:6707 DEMOCRACY BLVD STE 504
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-1166
Practice Address - Country:US
Practice Address - Phone:301-637-8712
Practice Address - Fax:410-290-4488
Is Sole Proprietor?:No
Enumeration Date:2010-11-10
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD23480225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist