MEDICARE: MALANA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1023691367
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MALANA LLC

Provider Business Mailing Address
First Line	:	6247 W REUBEN CIR
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84128-7515
Country	:	US
Telephone Number	:	801-735-7585
Fax Number	:

Provider Business Practice Location Address
First Line	:	6247 W REUBEN CIR
Second Line	:
City	:	WEST VALLEY CITY
State	:	UT
Zip	:	84128-7515
Country	:	US
Telephone Number	:	801-735-7585
Fax Number	:

Authorized Official
Title or Position	:	PHYSICAL THERAPIST
Name	:	BRADLEY ALLEN KLEMETSON
Credential	:	DPT
Telephone Number	:	801-735-7585

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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Directions to “MALANA LLC ” Practice Location

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