MEDICARE: MR. DAVID JOSEPH MALLONEE L.P.T.

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
1	225100000X	Physical Therapist	4141	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	231416	OTHER	OR	OMAP

General Provider Information

NPI Number	:	1326080326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID JOSEPH MALLONEE L.P.T.

Provider Business Mailing Address
First Line	:	4762 SE 51ST ST
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-1442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3007 NE WEST DEVILS LAKE RD
Second Line	:
City	:	LINCOLN CITY
State	:	OR
Zip	:	97367-5131
Country	:	US
Telephone Number	:	541-994-6252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	07/08/2007

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Directions to “ MR. DAVID JOSEPH MALLONEE L.P.T.” Practice Location

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