Healthcare Provider Details

I. General information

NPI: 1336004423
Provider Name (Legal Business Name): MILITZA MARRIE MOLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 PENN AVE
WYOMISSING PA
19610-2143
US

IV. Provider business mailing address

1013 SAYLOR DR
TEMPLE PA
19560-9587
US

V. Phone/Fax

Practice location:
  • Phone: 484-820-0210
  • Fax:
Mailing address:
  • Phone: 610-780-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMSG015557
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: