MEDICARE: MS. MOLLY HAMILTON DPT

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	225100000X	Physical Therapist	8396	MN

General Provider Information

NPI Number	:	1417336710
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MOLLY HAMILTON DPT

Provider Business Mailing Address
First Line	:	9133 PARKSIDE DR
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-7512
Country	:	US
Telephone Number	:	651-815-5419
Fax Number	:

Provider Business Practice Location Address
First Line	:	7012 LAKE RD
Second Line	:
City	:	WOODBURY
State	:	MN
Zip	:	55125-2433
Country	:	US
Telephone Number	:	651-287-6487
Fax Number	:

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

Provider Enumeration Date	:	05/20/2015
Last Update Date	:	05/20/2015

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