Healthcare Provider Details

I. General information

NPI: 1558936385
Provider Name (Legal Business Name): BRIAN MATTHEW MALONE PT, DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20801 N SCOTTSDALE RD STE 105
SCOTTSDALE AZ
85255-6487
US

IV. Provider business mailing address

13009 W LISBON LN
EL MIRAGE AZ
85335-3402
US

V. Phone/Fax

Practice location:
  • Phone: 623-208-7575
  • Fax:
Mailing address:
  • Phone: 406-880-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberLPT-31640
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: