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NPI Code Detail

MEDICARE: BROOKE ASHLEY MALLOY DPT

MEDICARE:   BROOKE ASHLEY MALLOY  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 Therapist2305212755VA
2225100000XPhysical TherapistPTL.0018266CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750948352
Entity Type Code : Individual
Provider Name (Legal Business Name) : BROOKE ASHLEY MALLOY DPT
Provider Business Mailing Address
First Line : 3841 GREEN HILLS VILLAGE DR STE 200
Second Line :
City : NASHVILLE
State : TN
Zip : 37215-2691
Country : US
Telephone Number : 615-936-2000
Fax Number :
Provider Business Practice Location Address
First Line : 3601 THE VANDERBILT CLINIC
Second Line :
City : NASHVILLE
State : TN
Zip : 37232-2813
Country : US
Telephone Number : 615-936-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2019
Last Update Date : 03/17/2026

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