Individual
JONATHAN MALONE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA/ATC
Contact information
Practice address
1215 ALICE DR, SUMTER, SC 29150-1905
(803) 774-5201
(803) 774-5211
Mailing address
1215 ALICE DR, SUMTER, SC 29150-1905
(803) 774-5201
(803) 774-5211
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
1997
SC
Other
Enumeration date
09/13/2011
Last updated
09/13/2011
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