Provider Demographics
NPI:1700923869
Name:MALONE, AMY LYNNE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:LYNNE
Last Name:MALONE
Suffix:
Gender:F
Credentials:MPT
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 5776
Mailing Address - Street 2:
Mailing Address - City:VANCLEAVE
Mailing Address - State:MS
Mailing Address - Zip Code:39565-5776
Mailing Address - Country:US
Mailing Address - Phone:228-826-1696
Mailing Address - Fax:
Practice Address - Street 1:11010 DAVID ST
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3481
Practice Address - Country:US
Practice Address - Phone:228-832-8327
Practice Address - Fax:228-832-8328
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPTH3835225100000X
MSPT3406225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist