Provider Demographics
NPI:1033958665
Name:MALYSA, WILLIAM (DPT)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MALYSA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 ALAMEDA TRACE CIR APT 1927
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-7606
Mailing Address - Country:US
Mailing Address - Phone:708-539-8015
Mailing Address - Fax:
Practice Address - Street 1:117B LOUIS HENNA BLVD
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-7307
Practice Address - Country:US
Practice Address - Phone:512-388-3687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13926332251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic