MEDICARE: MOLLY DOMINIQUE MCDONALD DPT

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
1	225100000X	Physical Therapist	3641	NH

General Provider Information

NPI Number	:	1528349685
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY DOMINIQUE MCDONALD DPT

Provider Business Mailing Address
First Line	:	14555 PHILIPPINE ST
Second Line	:	1131
City	:	HOUSTON
State	:	TX
Zip	:	77040-7804
Country	:	US
Telephone Number	:	832-276-7095
Fax Number	:

Provider Business Practice Location Address
First Line	:	11120 NORTH FWY STE E
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77037-1029
Country	:	US
Telephone Number	:	281-875-1800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/09/2014

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