Healthcare Provider Details

I. General information

NPI: 1225165301
Provider Name (Legal Business Name): STEVEN VINCENT MALONE P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2974 LA VENTANA PKWY
DRIFTWOOD TX
78619-4266
US

IV. Provider business mailing address

2974 LA VENTANA PKWY
DRIFTWOOD TX
78619-4266
US

V. Phone/Fax

Practice location:
  • Phone: 512-757-4900
  • Fax: 512-858-7760
Mailing address:
  • Phone: 512-757-4900
  • Fax: 512-858-7760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number1155350
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: