MEDICARE: TAMMY JANE MALONEY 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
1	225200000X	Physical Therapy Assistant

General Provider Information

NPI Number	:	1386602951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY JANE MALONEY PTA

Provider Business Mailing Address
First Line	:	1822 W LIBERTY AVE
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99205-2566
Country	:	US
Telephone Number	:	509-777-0610
Fax Number	:

Provider Business Practice Location Address
First Line	:	5011 W LOWELL AVE
Second Line	:	STE 120
City	:	SPOKANE
State	:	WA
Zip	:	99208-8587
Country	:	US
Telephone Number	:	509-777-0610
Fax Number	:

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

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	07/08/2007

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