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General NPI Number Information
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NPI Number | 1871074062
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Entity Type | Individual
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Provider Name | JOHN MOLENDA
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Gender | Male
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Dates
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Enumeration Date | 08/24/2018
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 4725 BELLWETHER LN
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City | OXFORD
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State | FL
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Zip | 34484-2980
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Country | US
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Telephone | 352-430-0076
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Fax |
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Provider Business Mailing Address
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Address Line | 3398 COUNTRYSIDE PATH
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City | THE VILLAGES
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State | FL
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Zip | 32163-2438
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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 | PTA27811
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License Number State | FL
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