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NPI Code Detail

MEDICARE: DR. MICAH JAMES MALY DPT

MEDICARE: DR. MICAH JAMES MALY DPT
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 Therapist61816OR
2225100000XPhysical Therapist0013435CO
3225100000XPhysical Therapist003501WV
4225100000XPhysical Therapist0000010852TN
52251X0800XOrthopedic Physical Therapist0013435CO

General Provider Information

NPI Number : 1053861666
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICAH JAMES MALY DPT
Provider Business Mailing Address
First Line : 744 GRAND MARKET AVE
Second Line :
City : BERTHOUD
State : CO
Zip : 80513-2710
Country : US
Telephone Number : 970-290-5708
Fax Number :
Provider Business Practice Location Address
First Line : 730 14TH ST SW
Second Line :
City : LOVELAND
State : CO
Zip : 80537-6349
Country : US
Telephone Number : 970-663-0815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2016
Last Update Date : 10/03/2022

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