Basic Information
| Provider Information | |||||||||
| NPI: | 1942438296 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARALIT | ||||||||
| FirstName: | JOSEPH BENEDICT | ||||||||
| MiddleName: | MALABANAN | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3180 TINA LN | ||||||||
| Address2: | |||||||||
| City: | MARIETTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300664312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705171080 | ||||||||
| FaxNumber: | 7705171083 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 MOLLY LN | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | WOODSTOCK | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301896503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705171080 | ||||||||
| FaxNumber: | 7705171083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2009 | ||||||||
| LastUpdateDate: | 06/26/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT009426 | GA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.