=====================================================
General NPI Number Information
=====================================================
NPI Number | 1790648079
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | VIDA MOLEK
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/04/2025
-----------------------------------------------------
Last Update Date | 12/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12320 LINCOLN HWY E
-----------------------------------------------------
City | IRWIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15642-2590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-401-3783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12320 LINCOLN HWY E
-----------------------------------------------------
City | IRWIN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 15642-2590
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 412-401-3783
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225700000X
-----------------------------------------------------
Taxonomy Name | Massage Therapist
-----------------------------------------------------
License Number | MSG016653
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------