Provider Demographics
NPI:1225643471
Name:CRINO, MOLLY K
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:K
Last Name:CRINO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2024 S ALLPORT ST APT 1M
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-3870
Mailing Address - Country:US
Mailing Address - Phone:312-937-7729
Mailing Address - Fax:
Practice Address - Street 1:2024 S ALLPORT ST APT 1M
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-3870
Practice Address - Country:US
Practice Address - Phone:312-937-7729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL227018213225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist