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General NPI Number Information
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NPI Number | 1699982199
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Entity Type | Individual
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Provider Name | MOLLY HOGAN MIKULS MPT
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Gender | Female
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2700 W NORFOLK AVE
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City | NORFOLK
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State | NE
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Zip | 68701-4438
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Country | US
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Telephone | 402-644-7546
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Fax |
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Provider Business Mailing Address
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Address Line | 5602 WALNUT ST
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City | OMAHA
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State | NE
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Zip | 68106-2263
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Country | US
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Telephone | 402-630-8114
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2005
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License Number State | NE
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