Provider Demographics
NPI:1033669759
Name:NEWMAN, MOLLY (PT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6143 SW VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3600
Mailing Address - Country:US
Mailing Address - Phone:503-901-1796
Mailing Address - Fax:
Practice Address - Street 1:6143 SW VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3600
Practice Address - Country:US
Practice Address - Phone:503-901-1796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR60627225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist