Provider Demographics
NPI:1093028557
Name:ANDERSON, MOLLY JO (PT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY JO
Middle Name:
Last Name:ANDERSON
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 1:4125 145TH ST
Mailing Address - Street 2:
Mailing Address - City:ESTHERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:51334-7411
Mailing Address - Country:US
Mailing Address - Phone:712-260-4409
Mailing Address - Fax:
Practice Address - Street 1:826 N 8TH ST
Practice Address - Street 2:
Practice Address - City:ESTHERVILLE
Practice Address - State:IA
Practice Address - Zip Code:51334-1528
Practice Address - Country:US
Practice Address - Phone:712-362-6118
Practice Address - Fax:712-362-6331
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-26
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist