Provider Demographics
NPI:1710039235
Name:MALATE, FRANCISCO TARROBAGO III (PT)
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:TARROBAGO
Last Name:MALATE
Suffix:III
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:FRANCE
Other - Middle Name:
Other - Last Name:MALATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:4636 N KENNICOTT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630-4338
Mailing Address - Country:US
Mailing Address - Phone:773-777-2136
Mailing Address - Fax:
Practice Address - Street 1:4636 N KENNICOTT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630-4338
Practice Address - Country:US
Practice Address - Phone:773-777-2136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070007499225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist