Individual
KATEASTA NICOLE MALLOY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
95 COLONIAL HEIGHTS DR, FORT ASHBY, WV 26719-6962
(301) 876-8087
Mailing address
95 COLONIAL HEIGHTS DR, FORT ASHBY, WV 26719-6962
(301) 876-8087
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
001265
WV
Other
Enumeration date
10/29/2024
Last updated
10/29/2024
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