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General NPI Number Information
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NPI Number | 1194209205
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Entity Type | Individual
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Provider Name | JACK MALAFRONTE PT, DPT, ATC
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Gender | Male
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Dates
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Enumeration Date | 09/25/2018
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 1776 REVOLUTION WAY
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City | FOXBOROUGH
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State | MA
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Zip | 02035-1157
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Country | US
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Telephone | 781-812-8209
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Fax |
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Provider Business Mailing Address
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Address Line | 40 SHERI LN
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City | WEYMOUTH
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State | MA
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Zip | 02190-1241
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Country | US
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Telephone |
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Fax |
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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 | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | 36267
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | ATL3113
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 6080
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PTL27656
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License Number State | MA
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