Healthcare Provider Details

I. General information

NPI: 1336543743
Provider Name (Legal Business Name): MOLLY OLIVIA ROFFMAN PT MA CEEAA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2014
Last Update Date: 01/01/2020
Certification Date: 01/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 S HIGHLAND AVE STE 109
BRIARCLIFF MANOR NY
10510-2096
US

IV. Provider business mailing address

325 S HIGHLAND AVE STE 109
BRIARCLIFF MANOR NY
10510-2096
US

V. Phone/Fax

Practice location:
  • Phone: 914-486-8125
  • Fax:
Mailing address:
  • Phone: 914-292-0602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001586
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number011586-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: