Individual ProviderKelly J MalmquistPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPractice Address1040 Pilgrim Way, Green Bay, WI 54304-5028(920) 405-3522(920) 209-0915PECOS EnrollmentBased on the most recent information from CMS, provider Kelly J Malmquist does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1609922665Provider TypeIndividualFull NameMalmquist, Kelly JTitleMrs.CredentialPTAGenderFemaleSole ProprietorNoEnumeration Date1/25/2007Last Updated4/23/2012Contact InformationPractice LocationPractice Address1040 Pilgrim Way, Green Bay, WI 54304-5028Phone(920) 405-3522Fax(920) 405-3523Mailing LocationMailing Address360 Mark Court, Neenah, WI 54956Phone(920) 209-0915FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode225200000XPrimaryDescriptionPhysical Therapy AssistantRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersLicense1321019WisconsinProvider IdentifiersIDDescriptionIssuerID36120300DescriptionMedicaidIssuerUnlistedWisconsin