Healthcare Provider Details

I. General information

NPI: 1770767667
Provider Name (Legal Business Name): ROBERT JONATHON MALONEY JR. P.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 OAK ST
FARMVILLE VA
23901-1199
US

IV. Provider business mailing address

15 SHILOH CT
PALMYRA VA
22963-3217
US

V. Phone/Fax

Practice location:
  • Phone: 434-315-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2305204789
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: