Individual
MISS REBECCA ANN MALCOLM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
41150 WOODWARD AVE, BLOOMFIELD HILLS, MI 48304-5020
(248) 397-5792
Mailing address
33755 NEWPORT DR, STERLING HEIGHTS, MI 48310-5861
(734) 915-0445
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236612
—
MI
Enumeration date
04/05/2006
Last updated
12/02/2015
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