Basic Information
| Provider Information | |||||||||
| NPI: | 1184953960 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MALONZO | ||||||||
| FirstName: | LORALIE | ||||||||
| MiddleName: | DIMACALI | ||||||||
| NamePrefix: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MALONZO | ||||||||
| OtherFirstName: | LORALIE | ||||||||
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| OtherCredential: | PT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1920 OLD SPRINGVILLE ROAD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2055209600 | ||||||||
| FaxNumber: | 2055200455 | ||||||||
| Practice Location | |||||||||
| Address1: | 1920 OLD SPRINGVILLE RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35215 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8008544589 | ||||||||
| FaxNumber: | 2055200455 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2009 | ||||||||
| LastUpdateDate: | 12/08/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 2009032715 | MO | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 070.016201 | IL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | WW0042880 | 01 | PHILIPPINE PASSPORT NUMBER | OTHER |