Provider Demographics
NPI:1942758040
Name:MALVE, SAMUEL III
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:
Last Name:MALVE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7014 BEARGRASS RD
Mailing Address - Street 2:
Mailing Address - City:HARMONY
Mailing Address - State:FL
Mailing Address - Zip Code:34773-9179
Mailing Address - Country:US
Mailing Address - Phone:813-841-7465
Mailing Address - Fax:
Practice Address - Street 1:7014 BEARGRASS RD
Practice Address - Street 2:
Practice Address - City:HARMONY
Practice Address - State:FL
Practice Address - Zip Code:34773-9179
Practice Address - Country:US
Practice Address - Phone:813-841-7465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-17
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL336269224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant