Healthcare Provider Details

I. General information

NPI: 1316347156
Provider Name (Legal Business Name): MOLLIE NEWMAN ATC, PT, DPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2014
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 STATE ROUTE 45
LISBON OH
44432-8342
US

IV. Provider business mailing address

912 E LINCOLNWAY
MINERVA OH
44657-1214
US

V. Phone/Fax

Practice location:
  • Phone: 330-424-9033
  • Fax: 330-424-9053
Mailing address:
  • Phone: 330-868-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT018822
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: