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General NPI Number Information
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NPI Number | 1477564730
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Entity Type | Individual
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Provider Name | THOMAS MOLLSEN
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 1355 E GOLF RD STE 100
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City | DES PLAINES
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State | IL
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Zip | 60016-1544
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Country | US
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Telephone | 847-376-8289
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Fax | 224-938-9654
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Provider Business Mailing Address
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Address Line | 1355 E GOLF RD STE 100
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City | DES PLAINES
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State | IL
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Zip | 60016-1544
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Country | US
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Telephone | 847-376-8289
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Fax | 224-938-9654
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070013496
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License Number State | IL
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