Healthcare Provider Details

I. General information

NPI: 1871074062
Provider Name (Legal Business Name): JOHN MOLENDA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 BELLWETHER LN
OXFORD FL
34484-2980
US

IV. Provider business mailing address

3398 COUNTRYSIDE PATH
THE VILLAGES FL
32163-2438
US

V. Phone/Fax

Practice location:
  • Phone: 352-430-0076
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA27811
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: