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General NPI Number Information
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NPI Number | 1659025807
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Entity Type | Individual
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Provider Name | KENNA MALCOM DPT
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Gender | Female
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Dates
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Enumeration Date | 02/07/2022
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Last Update Date | 02/07/2022
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Provider Practice Location Address
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Address Line | 2045 BROADWATER AVE STE 3
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City | BILLINGS
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State | MT
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Zip | 59102-4869
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Country | US
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Telephone | 406-656-0950
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 711185
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City | SALT LAKE CITY
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State | UT
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Zip | 84171-1185
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PTP-PT-LIC-22272
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License Number State | MT
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