Provider Demographics
NPI:1033193255
Name:BROE, MOLLY KATHERINE (PT, DPT, OCS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATHERINE
Last Name:BROE
Suffix:
Gender:F
Credentials:PT, DPT, OCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3451 S CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-5073
Mailing Address - Country:US
Mailing Address - Phone:303-680-6121
Mailing Address - Fax:303-680-8627
Practice Address - Street 1:3451 S CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-5073
Practice Address - Country:US
Practice Address - Phone:303-680-6121
Practice Address - Fax:303-680-8627
Is Sole Proprietor?:No
Enumeration Date:2005-12-01
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0012722225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0206952OtherWA DEPT OF LABOR
CAQ55369Medicare UPIN
CABF745ZMedicare PIN
CA0PT300760Medicare PIN
CABF745YMedicare PIN