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General NPI Number Information
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NPI Number | 1063878254
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Entity Type | Individual
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Provider Name | MOLLIE AYERS
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Gender | Female
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Dates
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Enumeration Date | 01/05/2016
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Last Update Date | 01/05/2016
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Provider Practice Location Address
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Address Line | 28100 TORCH PKWY SUITE 600
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City | WARRENVILLE
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State | IL
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Zip | 60555-3938
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Country | US
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Telephone | 717-581-4379
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Fax |
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Provider Business Mailing Address
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Address Line | 1954 LARCH AVE
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City | EAST PETERSBURG
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State | PA
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Zip | 17520-1306
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | TEI004313
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License Number State | PA
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