Provider Demographics
NPI:1306817879
Name:MOLSICK, DEBRA J (PT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:J
Last Name:MOLSICK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:DEBRA
Other - Middle Name:J
Other - Last Name:KETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:62 BURR RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-4705
Mailing Address - Country:US
Mailing Address - Phone:203-405-1199
Mailing Address - Fax:
Practice Address - Street 1:62 BURR RD
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-4705
Practice Address - Country:US
Practice Address - Phone:203-405-1199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003848225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist