Healthcare Provider Details

I. General information

NPI: 1134778582
Provider Name (Legal Business Name): JAMIE MALOY DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2019
Last Update Date: 09/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20109 AURORA AVE N STE 105
SHORELINE WA
98133-3127
US

IV. Provider business mailing address

23430 55TH AVE W UNIT B
MOUNTLAKE TERRACE WA
98043-5222
US

V. Phone/Fax

Practice location:
  • Phone: 206-801-7546
  • Fax:
Mailing address:
  • Phone: 509-302-1232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT60993861
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: