Provider Demographics
NPI:1235561762
Name:HABERICHTER, MOLLY HELENE (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:HELENE
Last Name:HABERICHTER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:HELENE
Other - Last Name:RIXEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:516 MONTGOMERY ST
Mailing Address - Street 2:
Mailing Address - City:DECORAH
Mailing Address - State:IA
Mailing Address - Zip Code:52101-2720
Mailing Address - Country:US
Mailing Address - Phone:563-794-0360
Mailing Address - Fax:
Practice Address - Street 1:516 MONTGOMERY ST
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-2720
Practice Address - Country:US
Practice Address - Phone:563-794-0360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA005152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA34706OtherBLUECROSS/BLUESHEILD IOWA
IA0000619Medicaid
NE1134142516OtherMIDLANDS CHOICE
MN1134142516OtherBLUE CROSS MN
UT1134142516OtherUNITED HEALTHCARE
MN421470451OtherMMSI
WI421470451OtherGUNDERSEN
MN10134142516OtherHEALTH PARTNERS
IA1134142516OtherCARE PROVIDER NETWORK
IA1134142516OtherCARE PROVIDER NETWORK