Provider Demographics
NPI:1245913615
Name:MALINAO, LEO ALPHONSUS SAN JOSE (PT, DPT)
Entity type:Individual
Prefix:
First Name:LEO ALPHONSUS
Middle Name:SAN JOSE
Last Name:MALINAO
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6779 LANTANA DR
Mailing Address - Street 2:
Mailing Address - City:BRYANS ROAD
Mailing Address - State:MD
Mailing Address - Zip Code:20616-4238
Mailing Address - Country:US
Mailing Address - Phone:229-366-0666
Mailing Address - Fax:
Practice Address - Street 1:501 CHURCH ST NE STE 105
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4734
Practice Address - Country:US
Practice Address - Phone:703-938-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2305215947225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist