Healthcare Provider Details

I. General information

NPI: 1508622077
Provider Name (Legal Business Name): MOLLY ROSE CARTER DPT, PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 03/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 NE MEDICAL CENTER DR STE 150
BEND OR
97701-5919
US

IV. Provider business mailing address

805 SW INDUSTRIAL WAY STE 3
BEND OR
97702-1093
US

V. Phone/Fax

Practice location:
  • Phone: 541-382-7875
  • Fax: 541-382-2181
Mailing address:
  • Phone: 541-382-7875
  • Fax: 541-382-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number65179
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: