MEDICARE: MATTHEW MALENA PT

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	4549	SC

General Provider Information

NPI Number	:	1306610951
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW MALENA PT

Provider Business Mailing Address
First Line	:	2462 HUNTERS TRL
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-8411
Country	:	US
Telephone Number	:	843-267-1804
Fax Number	:

Provider Business Practice Location Address
First Line	:	10607 HIGHWAY 707 UNIT 150
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29588-5555
Country	:	US
Telephone Number	:	843-267-1804
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/14/2023
Last Update Date	:	11/14/2023

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Directions to “ MATTHEW MALENA PT” Practice Location

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