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Individual
MR. MARK ALLEN MALMSTROM
Active
Individual
MR. MARK ALLEN MALMSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT002428
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000384741
ANTHEM
OH
05
—
2631398
—
OH
01
—
479351
PHCS
OH
01
—
P00323522
MEDICARE RAILROAD
OH
Enumeration date
01/19/2006
Last updated
07/13/2010
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