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NPI Code Detail

MEDICARE: STEPHANIE VANESSA MALGUY PTA

MEDICARE: STEPHANIE VANESSA MALGUY PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy AssistantA5876MD
2390200000XStudent in an Organized Health Care Education/Training ProgramMD
3225200000XPhysical Therapy AssistantCP029337AGA

General Provider Information

NPI Number : 1205553708
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE VANESSA MALGUY PTA
Provider Business Mailing Address
First Line : 101 FIELDSTONE CT
Second Line :
City : FREDERICK
State : MD
Zip : 21702-3279
Country : US
Telephone Number : 703-740-6106
Fax Number :
Provider Business Practice Location Address
First Line : 3750 PEACHTREE RD NE
Second Line :
City : ATLANTA
State : GA
Zip : 30319-1385
Country : US
Telephone Number : 404-261-6611
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2022
Last Update Date : 03/08/2024

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