Provider Demographics
NPI:1770622599
Name:NATION, MALCOLM DANIEL (PT)
Entity type:Individual
Prefix:MR
First Name:MALCOLM
Middle Name:DANIEL
Last Name:NATION
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 2ND ST
Mailing Address - Street 2:
Mailing Address - City:LOS BANOS
Mailing Address - State:CA
Mailing Address - Zip Code:93635-4124
Mailing Address - Country:US
Mailing Address - Phone:209-826-8623
Mailing Address - Fax:209-826-1433
Practice Address - Street 1:820 2ND ST
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-4124
Practice Address - Country:US
Practice Address - Phone:209-826-8623
Practice Address - Fax:209-826-1433
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT13316225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPT133160Medicare ID - Type Unspecified