Healthcare Provider Details

I. General information

NPI: 1528312428
Provider Name (Legal Business Name): KRISTEN PAIGE MALIN DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLEAVER FARM RD SUITE 400
MIDDLETOWN DE
19709-1630
US

IV. Provider business mailing address

200 CLEAVER FARM RD SUITE 400
MIDDLETOWN DE
19709-1630
US

V. Phone/Fax

Practice location:
  • Phone: 302-389-7855
  • Fax: 302-449-2047
Mailing address:
  • Phone: 302-449-2048
  • Fax: 302-449-2047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberJ1-0002822
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: