Provider Demographics
NPI:1164187985
Name:MALONE, KIARA JANESE (DPT, PT, ATC, LAT)
Entity type:Individual
Prefix:MS
First Name:KIARA
Middle Name:JANESE
Last Name:MALONE
Suffix:
Gender:F
Credentials:DPT, PT, ATC, LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1044 SIERRA GORDA DR
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-4556
Mailing Address - Country:US
Mailing Address - Phone:423-580-6714
Mailing Address - Fax:
Practice Address - Street 1:511 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3230
Practice Address - Country:US
Practice Address - Phone:215-923-6031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-05
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN14719225100000X
TN30252255A2300X
PART0083562255A2300X
390200000X
PAPT032259225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program