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NPI Code Detail

MEDICARE: ELIZABETH MOLLING PTA

MEDICARE: ELIZABETH MOLLING PTA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225200000XPhysical Therapy Assistant1983-19WI

General Provider Information

NPI Number : 1154724466
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH MOLLING PTA
Provider Business Mailing Address
First Line : 3850 S POHL DR
Second Line :
City : NEW BERLIN
State : WI
Zip : 53151-9019
Country : US
Telephone Number : 414-507-4893
Fax Number :
Provider Business Practice Location Address
First Line : 7500 W NORTH AVE
Second Line :
City : WAUWATOSA
State : WI
Zip : 53213-1717
Country : US
Telephone Number : 414-258-6170
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/30/2014
Last Update Date : 09/30/2014

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