Provider Demographics
NPI:1295060606
Name:A. MALASKA, PT, PC
Entity type:Organization
Organization Name:A. MALASKA, PT, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:WILSON
Authorized Official - Last Name:MALASKA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:405-245-0625
Mailing Address - Street 1:9604 PHEASANT LN
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73162-6423
Mailing Address - Country:US
Mailing Address - Phone:405-245-0625
Mailing Address - Fax:
Practice Address - Street 1:9604 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73162-6423
Practice Address - Country:US
Practice Address - Phone:405-245-0625
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-03
Last Update Date:2009-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2541261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy