Basic Information
| Provider Information | |||||||||
| NPI: | 1013962208 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MALGARINI | ||||||||
| FirstName: | MIMI | ||||||||
| MiddleName: | COLETTE | ||||||||
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| Credential: | P.T. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 450 | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983830450 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606986630 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Practice Location | |||||||||
| Address1: | 4409 NW ANDERSON HILL RD | ||||||||
| Address2: | |||||||||
| City: | SILVERDALE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983836807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606986630 | ||||||||
| FaxNumber: | 3606987002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 03/26/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | PT00006454 | WA | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
ID Information
| ID | Type | State | Issuer | Description | 810588134-02 | 01 | WA | KPS HEALTH PLANS | OTHER | 0162547 | 01 | WA | DEPT OF LABOR & INDUSTRIE | OTHER | 0279230 | 01 | WA | LABOR AND INDRUSTRIES | OTHER | 9119MA | 01 | WA | REGENCE BLUE SHIELD | OTHER | 5161656 | 01 | WA | AETNA/LEXINGTON, KY | OTHER |