Healthcare Provider Details

I. General information

NPI: 1922125616
Provider Name (Legal Business Name): KAY MARIE MALLOY PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MAGNOLIA CIR SE
NORTH CANTON OH
44709-1183
US

IV. Provider business mailing address

649 KNOLL ST SE
NORTH CANTON OH
44709
US

V. Phone/Fax

Practice location:
  • Phone: 330-494-2833
  • Fax: 330-494-2840
Mailing address:
  • Phone: 330-494-2833
  • Fax: 330-494-2840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2925
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: