Provider Demographics
NPI:1972291045
Name:MALEKI PHYSICAL THERAPY SERVICES
Entity Type:Organization
Organization Name:MALEKI PHYSICAL THERAPY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:GHANEM
Authorized Official - Last Name:MALEKI
Authorized Official - Suffix:
Authorized Official - Credentials:PT, DPT, CSMT
Authorized Official - Phone:701-730-1888
Mailing Address - Street 1:7131 W BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83709-1925
Mailing Address - Country:US
Mailing Address - Phone:701-730-1888
Mailing Address - Fax:
Practice Address - Street 1:671 E RIVERPARK LN
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83706-4066
Practice Address - Country:US
Practice Address - Phone:218-590-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty