Healthcare Provider Details

I. General information

NPI: 1083839104
Provider Name (Legal Business Name): MOLLY M GROSS PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 W 78TH ST STE 200
EDINA MN
55439-2560
US

IV. Provider business mailing address

1030 LILAC DR N
GOLDEN VALLEY MN
55422-4618
US

V. Phone/Fax

Practice location:
  • Phone: 952-914-8065
  • Fax: 952-914-8071
Mailing address:
  • Phone: 952-212-1375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number7758
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: