Healthcare Provider Details

I. General information

NPI: 1003748229
Provider Name (Legal Business Name): MOLLY JEAN SICARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST
BOSTON MA
02111-1552
US

IV. Provider business mailing address

48 BOYLSTON ST APT 1L
JAMAICA PLAIN MA
02130-4442
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-5000
  • Fax:
Mailing address:
  • Phone: 651-775-8293
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number27211
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: