Healthcare Provider Details

I. General information

NPI: 1376161638
Provider Name (Legal Business Name): MOLLY SOTO DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 06/27/2023
Certification Date: 06/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 N EUCLID AVE
SAINT LOUIS MO
63108-1567
US

IV. Provider business mailing address

9 N EUCLID AVE UNIT 613
SAINT LOUIS MO
63108-1484
US

V. Phone/Fax

Practice location:
  • Phone: 314-566-1540
  • Fax:
Mailing address:
  • Phone: 314-566-1540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number2021006417
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number070.025209
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: