Provider Demographics
NPI:1922125616
Name:MALLOY, KAY MARIE (PT)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:MARIE
Last Name:MALLOY
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 KNOLL ST SE
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44709
Mailing Address - Country:US
Mailing Address - Phone:330-494-2833
Mailing Address - Fax:330-494-2840
Practice Address - Street 1:700 MAGNOLIA CIR SE
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44709-1183
Practice Address - Country:US
Practice Address - Phone:330-494-2833
Practice Address - Fax:330-494-2840
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT2925225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHMA4132041Medicare PIN