Provider Demographics
NPI:1881931012
Name:MALACHOWSKI, ANA CHRISTINA (LMT, MMP,)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:CHRISTINA
Last Name:MALACHOWSKI
Suffix:
Gender:F
Credentials:LMT, MMP,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 N HARLEQUIN DR
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:86314-3714
Mailing Address - Country:US
Mailing Address - Phone:928-308-2723
Mailing Address - Fax:928-778-0772
Practice Address - Street 1:728 N MONTEZUMA ST STE A
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-2090
Practice Address - Country:US
Practice Address - Phone:928-778-0147
Practice Address - Fax:928-778-0772
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMT-15916225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist