Provider Demographics
NPI:1083160022
Name:MOLYNEUX-ELLIOT, THOMAS HENRY (DPT)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:MOLYNEUX-ELLIOT
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4052 MOTHER LODE DR
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8491
Mailing Address - Country:US
Mailing Address - Phone:425-444-0861
Mailing Address - Fax:
Practice Address - Street 1:4052 MOTHER LODE DR
Practice Address - Street 2:
Practice Address - City:SHINGLE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:95682-8491
Practice Address - Country:US
Practice Address - Phone:530-677-5092
Practice Address - Fax:916-933-0871
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT60650077225100000X
CA301991225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist