Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225100000X | Physical Therapist | ||
Y | 2251P0200X | Physical Therapist - Pediatrics |
NPI | 1083043426 |
---|---|
Provider Name | Tamra Molinelli |
First Address | Bellevue, NE 68005-5257 |
Second Address | Bellevue, NE 68005-5257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2013 |
Last Update Date | 06/11/2013 |