MEDICARE: MS. VIKKI MICHELE MOLINA PT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2251P0200X	Pediatric Physical Therapist	1140945	TX
2	225100000X	Physical Therapist	1140945	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356425714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. VIKKI MICHELE MOLINA PT

Provider Business Mailing Address
First Line	:	PO BOX 720157
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-0157
Country	:	US
Telephone Number	:	956-682-6900
Fax Number	:	956-682-8445

Provider Business Practice Location Address
First Line	:	1002 W SAM HOUSTON
Second Line	:	SUITE 10
City	:	PHARR
State	:	TX
Zip	:	78577-5198
Country	:	US
Telephone Number	:	956-702-9882
Fax Number	:	956-702-9886

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	12/29/2011

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