Provider Demographics
NPI:1871870527
Name:MALISH, ELIZABETH (LMT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MALISH
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 WEST MAIN STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2400
Mailing Address - Country:US
Mailing Address - Phone:330-677-3628
Mailing Address - Fax:330-677-4931
Practice Address - Street 1:307 W MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2400
Practice Address - Country:US
Practice Address - Phone:330-677-3628
Practice Address - Fax:330-677-4931
Is Sole Proprietor?:No
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH33018492225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist