Provider Demographics
NPI:1245628502
Name:FRANCO, MALERIE LYNN (PT DPT)
Entity type:Individual
Prefix:
First Name:MALERIE
Middle Name:LYNN
Last Name:FRANCO
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:MALERIE
Other - Middle Name:LYNN
Other - Last Name:RODERIGUES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT DPT
Mailing Address - Street 1:36576 RANCH HOUSE ST
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-3014
Mailing Address - Country:US
Mailing Address - Phone:951-970-8739
Mailing Address - Fax:
Practice Address - Street 1:26881 JEFFERSON AVE STE C
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-9180
Practice Address - Country:US
Practice Address - Phone:951-970-8739
Practice Address - Fax:951-379-1501
Is Sole Proprietor?:No
Enumeration Date:2015-01-08
Last Update Date:2021-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42146225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA160997Medicare PIN
CACA160996Medicare PIN
CACB238017Medicare PIN
CACA160995Medicare PIN