MEDICARE: MEGAN MALABANAN 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
1	225100000X	Physical Therapist

General Provider Information

NPI Number	:	1609454909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MEGAN MALABANAN DPT

Provider Business Mailing Address
First Line	:	1348 S WHITE AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-4448
Country	:	US
Telephone Number	:	909-539-5839
Fax Number	:

Provider Business Practice Location Address
First Line	:	1348 S WHITE AVE
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91766-4448
Country	:	US
Telephone Number	:	909-539-5839
Fax Number	:

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

Provider Enumeration Date	:	03/30/2021
Last Update Date	:	03/30/2021

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