Individual
DOUGLAS J. MALLERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.T.
Contact information
Practice address
9602 COLDWATER RD, SUITE 102, FORT WAYNE, IN 46825-2095
(260) 489-9887
(260) 489-9121
Mailing address
9602 COLDWATER RD, SUITE 102, FORT WAYNE, IN 46825-2095
(260) 489-9887
(260) 489-9121
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05003202
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200374590A
—
IN
Enumeration date
08/16/2005
Last updated
11/08/2010
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