Provider Demographics
NPI:1851743629
Name:MALANG, ROLANDO (PT, DPT)
Entity Type:Individual
Prefix:
First Name:ROLANDO
Middle Name:
Last Name:MALANG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 BOSQUE
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-7863
Mailing Address - Country:US
Mailing Address - Phone:575-725-1472
Mailing Address - Fax:
Practice Address - Street 1:357 BOSQUE
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-7863
Practice Address - Country:US
Practice Address - Phone:575-725-1472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1264085225100000X
NM4796225100000X
NMPT4796225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist