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NPI Code Detail

MEDICARE: MOLLY MARIE REDDEN PT

MEDICARE: MOLLY MARIE REDDEN 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
1225100000XPhysical Therapist2595NE

General Provider Information

NPI Number : 1558629154
Entity Type Code : Individual
Provider Name (Legal Business Name) : MOLLY MARIE REDDEN PT
Provider Business Mailing Address
First Line : 1200 PROVIDENCE RD
Second Line :
City : WAYNE
State : NE
Zip : 68787-1212
Country : US
Telephone Number : 402-375-7937
Fax Number :
Provider Business Practice Location Address
First Line : 1200 PROVIDENCE RD
Second Line :
City : WAYNE
State : NE
Zip : 68787-1212
Country : US
Telephone Number : 402-375-7937
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2012
Last Update Date : 05/02/2012

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