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General NPI Number Information
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NPI Number | 1154065522
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Entity Type | Individual
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Provider Name | JACKLYN MALARAN PT, DPT
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Gender | Female
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Dates
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Enumeration Date | 04/22/2022
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Last Update Date | 05/24/2023
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Provider Practice Location Address
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Address Line | 1281 E MAIN ST
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City | STAMFORD
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State | CT
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Zip | 06902-3544
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Country | US
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Telephone | 203-210-2840
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Fax | 203-210-2841
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Provider Business Mailing Address
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Address Line | 800 WESTCHESTER AVE STE N715
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City | RYE BROOK
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State | NY
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Zip | 10573-1369
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Country | US
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Telephone | 914-607-5730
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Fax | 914-457-1195
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 40QA02084400
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 13917
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License Number State | CT
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