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NPI Code Detail

MEDICARE: CORIE MALITZ

MEDICARE: CORIE MALITZ
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
1225100000XPhysical Therapist1479NV

General Provider Information

NPI Number : 1053678235
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORIE MALITZ
Provider Business Mailing Address
First Line : 7615 LUMBERJACK AVE
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-5362
Country : US
Telephone Number : 702-492-0637
Fax Number :
Provider Business Practice Location Address
First Line : 1120 N TOWN CENTER DR STE 120
Second Line :
City : LAS VEGAS
State : NV
Zip : 89144-6302
Country : US
Telephone Number : 866-960-7691
Fax Number : 866-960-7692
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/12/2012
Last Update Date : 04/12/2012

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Directions to “ CORIE MALITZ ” Practice Location

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