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General NPI Number Information
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NPI Number | 1528083227
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Entity Type | Organization
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Legal Business Name | TRACY L MALAN RPT APC
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Dates
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Enumeration Date | 07/13/2006
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Last Update Date | 06/23/2008
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Provider Practice Location Address
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Address Line | 525 MELISSA AVE STE B
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City | BARSTOW
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State | CA
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Zip | 92311-3002
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Country | US
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Telephone | 760-256-1888
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Fax | 760-256-2893
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Provider Business Mailing Address
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Address Line | 525 MELISSA AVE STE B
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City | BARSTOW
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State | CA
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Zip | 92311-3002
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Country | US
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Telephone | 760-256-1888
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Fax | 760-256-2893
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Authorized Official
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Title or Position | OWNER / CEO
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Name | TRACY L MALAN
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Credential | PT
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Telephone | 760-256-1888
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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 | PT12940
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License Number State | CA
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