Provider Demographics
NPI:1336141332
Name:LOWE, MOLLY MELISSA (PT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MELISSA
Last Name:LOWE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:MOLLY
Other - Middle Name:MELISSA
Other - Last Name:HARPER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:120 SANDTRAP DR
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:OK
Mailing Address - Zip Code:74701-1743
Mailing Address - Country:US
Mailing Address - Phone:580-920-5224
Mailing Address - Fax:580-677-9911
Practice Address - Street 1:120 SANDTRAP DR
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-1743
Practice Address - Country:US
Practice Address - Phone:580-920-5224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPT2365225100000X
TXPT1133726225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2495175002Medicare ID - Type Unspecified