Provider Demographics
NPI:1770253460
Name:MALLEY, MOIRA (DPT)
Entity type:Individual
Prefix:
First Name:MOIRA
Middle Name:
Last Name:MALLEY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOIRA
Other - Middle Name:GRACE
Other - Last Name:MALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPT
Mailing Address - Street 1:2122 YORK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-1925
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:166 SPRINGBROOK AVE STE 201
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:NC
Practice Address - Zip Code:27520-8520
Practice Address - Country:US
Practice Address - Phone:919-535-8461
Practice Address - Fax:919-535-8459
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047708225100000X
NCP20922225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist