Provider Demographics
NPI:1053852301
Name:WEINBENDER, MOLLY M (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:M
Last Name:WEINBENDER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:M
Other - Last Name:BILLINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:1327 SE TACOMA ST UNIT 122
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97202-6639
Mailing Address - Country:US
Mailing Address - Phone:503-716-6949
Mailing Address - Fax:888-645-6068
Practice Address - Street 1:1327 SE TACOMA ST UNIT 122
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97202-6639
Practice Address - Country:US
Practice Address - Phone:503-716-6949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-19
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR61696225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1053852301Medicaid