Provider Demographics
NPI:1245417153
Name:MOLLICK MACE, KRISTA LYNNE (ASSOCIATES)
Entity Type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:LYNNE
Last Name:MOLLICK MACE
Suffix:
Gender:F
Credentials:ASSOCIATES
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:
Other - Last Name:MACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:85 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033
Mailing Address - Country:US
Mailing Address - Phone:651-480-4168
Mailing Address - Fax:651-480-4339
Practice Address - Street 1:85 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033
Practice Address - Country:US
Practice Address - Phone:651-480-4168
Practice Address - Fax:651-480-4339
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant