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NPI Code Detail

MEDICARE: KRYSTEN W MALCOLM DPT

MEDICARE: KRYSTEN W MALCOLM DPT
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
1225100000XPhysical TherapistPT011518GA
2225100000XPhysical Therapist2305213355VA

General Provider Information

NPI Number : 1720494404
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRYSTEN W MALCOLM DPT
Provider Business Mailing Address
First Line : 504 ALBEMARLE SQ
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22901-7405
Country : US
Telephone Number : 434-817-7848
Fax Number : 434-465-6834
Provider Business Practice Location Address
First Line : 111 MONTICELLO AVE STE B
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22902-5698
Country : US
Telephone Number : 434-817-4276
Fax Number : 434-465-6836
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2014
Last Update Date : 01/20/2026

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