Provider Demographics
NPI:1225121015
Name:COLLIN, MOLLY E (PT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:E
Last Name:COLLIN
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 1:76 FRANCES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-2512
Mailing Address - Country:US
Mailing Address - Phone:207-775-9120
Mailing Address - Fax:
Practice Address - Street 1:170 US ROUTE 1
Practice Address - Street 2:SUITE 180
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2137
Practice Address - Country:US
Practice Address - Phone:207-781-5369
Practice Address - Fax:207-781-5862
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME#PT1944225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist