Active NPI
Brooke Mallaber
- Physical Therapist
- Livonia, NY
National Provider Identifier
1528423449
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 2305209670
- Practice address
- 113 Kensington CT
Livonia, NY 14487-9762 - Phone
- (585) 329-3716
- NPI assigned
- Dec 18, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 294610 | CA | |
| Physical Therapist | 225100000X | 2305209670 | NY | Primary |
Addresses
Primary practice location
113 Kensington CT
Livonia, NY 14487-9762
Mailing address
113 Kensington CT
Livonia, NY 14487-9762
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 294610 | CA | MD | Physical Therapist |
| 2305209670 | NY | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560211200000",
"number": "1528423449",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 KENSINGTON CT",
"city": "LIVONIA",
"state": "NY",
"postal_code": "144879762"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 KENSINGTON CT",
"city": "LIVONIA",
"state": "NY",
"postal_code": "144879762",
"telephone_number": "585-329-3716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLABER",
"first_name": "BROOKE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-18",
"last_updated": "2019-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "294610",
"primary": false
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NY",
"license": "2305209670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Livonia, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.