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Individual
PHILIP MALLOY
Active
Individual
PHILIP MALLOY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT003353L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01505402
CAPITAL
PA
01
—
075961
BLUE SHIELD
PA
01
—
484428
AETNA
PA
Enumeration date
10/14/2005
Last updated
12/23/2011
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