Healthcare Provider Details

I. General information

NPI: 1770795601
Provider Name (Legal Business Name): KATHRYN T MALONEY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2090 WOODWINDS DR
WOODBURY MN
55125-2522
US

IV. Provider business mailing address

710 COMMERCE DR STE 200
WOODBURY MN
55125-4925
US

V. Phone/Fax

Practice location:
  • Phone: 651-968-5801
  • Fax: 651-968-5899
Mailing address:
  • Phone: 651-968-5042
  • Fax: 651-968-5904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7859
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: