Provider Demographics
NPI:1215198585
Name:VERSCHUYL, MOLLY P (PT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:P
Last Name:VERSCHUYL
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:P
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:201 NE PARK PLAZA DR STE 246
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-5874
Mailing Address - Country:US
Mailing Address - Phone:360-696-1070
Mailing Address - Fax:
Practice Address - Street 1:201 NE PARK PLAZA DR STE 246
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-5874
Practice Address - Country:US
Practice Address - Phone:360-696-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4691225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist