Provider Demographics
NPI:1134407620
Name:MALAVE, REINALDO JOSE (ATC, LAT)
Entity type:Individual
Prefix:MR
First Name:REINALDO
Middle Name:JOSE
Last Name:MALAVE
Suffix:
Gender:M
Credentials:ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 S ORLANDO AVE
Mailing Address - Street 2:SUITE H
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-7102
Mailing Address - Country:US
Mailing Address - Phone:407-539-1792
Mailing Address - Fax:407-539-2228
Practice Address - Street 1:811 S ORLANDO AVE
Practice Address - Street 2:SUITE H
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-7102
Practice Address - Country:US
Practice Address - Phone:407-539-1792
Practice Address - Fax:407-539-2228
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAL31002255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer