Healthcare Provider Details

I. General information

NPI: 1316054786
Provider Name (Legal Business Name): MALFA SUGOY-SY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 04/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2385 NW EXECUTIVE DR. SUITE 100
BOCA RATON FL
33432
US

IV. Provider business mailing address

2385 NW EXECUTIVE DR. SUITE 100
BOCA RATON FL
33432
US

V. Phone/Fax

Practice location:
  • Phone: 808-391-0201
  • Fax:
Mailing address:
  • Phone: 808-391-0201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number25755
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: