Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251S0007X | Physical Therapist - Sports | 1079184 | TX |
NPI | 1477537959 |
---|---|
Provider Name | Joseph Martin Molloy |
First Address | San Antonio, TX 78209-3749 |
Second Address | Fort Sam Houston, TX 78234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2005 |
Last Update Date | 08/07/2007 |