=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932700960
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID ERIC MALACHOWSKI ONNE DPT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2020
-----------------------------------------------------
Last Update Date | 11/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 140 DIAMOND CREEK PL UNIT 125
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95747-7188
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 916-206-3612
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1821 DEVONSHIRE RD
-----------------------------------------------------
City | SACRAMENTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95864-1562
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-249-0186
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225100000X
-----------------------------------------------------
Taxonomy Name | Physical Therapist
-----------------------------------------------------
License Number | 299165
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------