MEDICARE: JEANNIE MARIE MOLLICK 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
1	225200000X	Physical Therapy Assistant	06466	OH

General Provider Information

NPI Number	:	1578437364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNIE MARIE MOLLICK PTA

Provider Business Mailing Address
First Line	:	8470 BEECH AVE APT 5
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-1855
Country	:	US
Telephone Number	:	440-812-5457
Fax Number	:

Provider Business Practice Location Address
First Line	:	8470 BEECH AVE APT 5
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-1855
Country	:	US
Telephone Number	:	440-812-5457
Fax Number	:

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

Provider Enumeration Date	:	10/03/2025
Last Update Date	:	10/03/2025

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