Provider Demographics
NPI:1144462169
Name:SUE MALONE PHYSICAL THERAPY LLC
Entity type:Organization
Organization Name:SUE MALONE PHYSICAL THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MALONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-417-9433
Mailing Address - Street 1:22 SHERWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEW MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06776-3317
Mailing Address - Country:US
Mailing Address - Phone:203-417-9433
Mailing Address - Fax:860-350-0285
Practice Address - Street 1:22 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:NEW MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06776-3317
Practice Address - Country:US
Practice Address - Phone:203-417-9433
Practice Address - Fax:860-350-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-06
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004046251E00000X, 261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004046OtherPHYSICAL THERAPY LICENSE