Provider Demographics
NPI:1457563538
Name:MALEK, ERIC EDWIN (ATC, LAT)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:EDWIN
Last Name:MALEK
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 65
Mailing Address - Street 2:
Mailing Address - City:PARADISE
Mailing Address - State:TX
Mailing Address - Zip Code:76073-0065
Mailing Address - Country:US
Mailing Address - Phone:940-393-0611
Mailing Address - Fax:
Practice Address - Street 1:700 SOUTH VICTORY WAY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747
Practice Address - Country:US
Practice Address - Phone:407-939-2313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT32472255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer