MEDICARE: MR. MALCOLM DANIEL NATION PT

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	PT13316	CA

General Provider Information

NPI Number	:	1770622599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MALCOLM DANIEL NATION PT

Provider Business Mailing Address
First Line	:	820 2ND ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4124
Country	:	US
Telephone Number	:	209-826-8623
Fax Number	:	209-826-1433

Provider Business Practice Location Address
First Line	:	820 2ND ST
Second Line	:
City	:	LOS BANOS
State	:	CA
Zip	:	93635-4124
Country	:	US
Telephone Number	:	209-826-8623
Fax Number	:	209-826-1433

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	08/03/2022

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