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General NPI Number Information
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NPI Number | 1497128508
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Entity Type | Organization
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Legal Business Name | MALO SPORTS REHABILITATION AND PHYSICAL THERAPY INC.
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Dates
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Enumeration Date | 11/11/2015
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Last Update Date | 11/13/2015
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Provider Practice Location Address
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Address Line | 7721 N 1ST ST
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City | FRESNO
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State | CA
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Zip | 93720-0962
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Country | US
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Telephone | 559-435-7472
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Fax | 559-570-0900
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Provider Business Mailing Address
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Address Line | 464 BLISS AVE
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City | CLOVIS
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State | CA
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Zip | 93611-0601
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Country | US
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Telephone | 559-435-7472
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Fax | 559-570-0900
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Authorized Official
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Title or Position | PRESIDENT/C.E.O.
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Name | DR. NATHANIEL J MALO
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Credential | D.P.T.
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Telephone | 559-435-7472
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number | 38220
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License Number State | CA
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