Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225100000X | Physical Therapist | 05013329A | IN |
N | 225100000X | Physical Therapist | PT31452 | FL |
NPI | 1003264946 |
---|---|
Provider Name | Molly Strother |
First Address | Newburgh, IN 47630-8940 |
Second Address | Newburgh, IN 47630-8940 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2016 |
Last Update Date | 04/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
300025473 | (05) | IN |
AM305 | MEDICARE PTAN (01) | FL |
DO0550 | RAILROAD MEDICARE (01) | |
Y907M | BC/BS ID (01) | |
Y927Q | BC/BS ID (01) |