Provider Demographics
NPI:1710034269
Name:MALLOY, RICHARD D (MPT)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:MALLOY
Suffix:
Gender:M
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11801 UPPER POTOMAC INDUSTRIAL PARK STREET
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-5139
Mailing Address - Country:US
Mailing Address - Phone:301-729-3485
Mailing Address - Fax:301-729-0158
Practice Address - Street 1:11801 UPPER POTOMAC INDUSTRIAL PARK STREET
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-5139
Practice Address - Country:US
Practice Address - Phone:301-729-3485
Practice Address - Fax:301-729-0158
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD21035225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist