MEDICARE: JOSHUA LUCAS MALONEY

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	PT5628	MS

General Provider Information

NPI Number	:	1760887483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA LUCAS MALONEY

Provider Business Mailing Address
First Line	:	147 LINKS DR
Second Line	:	38J
City	:	CANTON
State	:	MS
Zip	:	39046-5213
Country	:	US
Telephone Number	:	931-472-9908
Fax Number	:

Provider Business Practice Location Address
First Line	:	102 W RAILROAD AVE N
Second Line	:
City	:	CRYSTAL SPRINGS
State	:	MS
Zip	:	39059-2154
Country	:	US
Telephone Number	:	601-892-8707
Fax Number	:

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

Provider Enumeration Date	:	10/23/2014
Last Update Date	:	10/23/2014

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