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General NPI Number Information
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NPI Number | 1497434427
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Entity Type | Individual
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Provider Name | MOLLY V MCMULLEN PT, ATC
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Gender | Female
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Dates
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Enumeration Date | 07/17/2023
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Last Update Date | 07/17/2023
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Provider Practice Location Address
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Address Line | 6438 WILMINGTON PIKE
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City | CENTERVILLE
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State | OH
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Zip | 45459-7022
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Country | US
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Telephone | 938-558-3810
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Fax | 937-558-3811
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Provider Business Mailing Address
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Address Line | 1217 MCKINLEY CT
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City | MIAMISBURG
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State | OH
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Zip | 45342-4065
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Country | US
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Telephone | 269-426-0516
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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 | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | PT013649
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License Number State | OH
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