Healthcare Provider Details

I. General information

NPI: 1336141332
Provider Name (Legal Business Name): MOLLY MELISSA LOWE PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MOLLY MELISSA HARPER PT

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SANDTRAP DR
DURANT OK
74701-1743
US

IV. Provider business mailing address

120 SANDTRAP DR
DURANT OK
74701-1743
US

V. Phone/Fax

Practice location:
  • Phone: 580-920-5224
  • Fax:
Mailing address:
  • Phone: 580-920-5224
  • Fax: 580-677-9911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT2365
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT1133726
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: