Provider Demographics
NPI:1861843187
Name:MALONEY, THERESA ANN (MS, PT)
Entity Type:Individual
Prefix:MS
First Name:THERESA
Middle Name:ANN
Last Name:MALONEY
Suffix:
Gender:F
Credentials:MS, PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 COATES AVE
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-2415
Mailing Address - Country:US
Mailing Address - Phone:631-664-7981
Mailing Address - Fax:631-981-0754
Practice Address - Street 1:1014 COATES AVE
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741-2415
Practice Address - Country:US
Practice Address - Phone:631-664-7981
Practice Address - Fax:631-981-0754
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017371225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist