Healthcare Provider Details

I. General information

NPI: 1902320526
Provider Name (Legal Business Name): MOLLY M WHITE DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY E MAINE DPT

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12 BOKUM RD
ESSEX CT
06426-1500
US

IV. Provider business mailing address

2408 WHITNEY AVE
HAMDEN CT
06518-3209
US

V. Phone/Fax

Practice location:
  • Phone: 860-767-9053
  • Fax: 203-466-8527
Mailing address:
  • Phone: 203-626-0160
  • Fax: 203-294-6734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number11483
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: