Healthcare Provider Details

I. General information

NPI: 1639019763
Provider Name (Legal Business Name): MOLLY CROESSMANN PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 04/15/2026
Certification Date: 04/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4617 W 20TH ST UNIT A
GREELEY CO
80634-3207
US

IV. Provider business mailing address

35 MAHON RD
EDGEWOOD NM
87015-9439
US

V. Phone/Fax

Practice location:
  • Phone: 970-352-9022
  • Fax:
Mailing address:
  • Phone: 505-503-5536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number0021192
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: