MEDICARE: DR. CHAD L MOLEN D.P.T., CSCS

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	2163	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2163	OTHER	MT	LICENCE NUMBER

General Provider Information

NPI Number	:	1720237415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD L MOLEN D.P.T., CSCS

Provider Business Mailing Address
First Line	:	908 8TH AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-2165
Country	:	US
Telephone Number	:	406-454-0438
Fax Number	:	406-727-8550

Provider Business Practice Location Address
First Line	:	314 1ST AVE N
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59401-2506
Country	:	US
Telephone Number	:	406-454-0438
Fax Number	:	406-727-8550

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

Provider Enumeration Date	:	09/17/2008
Last Update Date	:	05/10/2023

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