Provider Demographics
NPI:1447765003
Name:MOLINA, MARIELA (PHYSICAL THERAPY AST)
Entity Type:Individual
Prefix:MS
First Name:MARIELA
Middle Name:
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PHYSICAL THERAPY AST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3705 W 20TH AVE STE 125
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4531
Mailing Address - Country:US
Mailing Address - Phone:305-557-4424
Mailing Address - Fax:
Practice Address - Street 1:3705 W 20TH AVE STE 125
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-4531
Practice Address - Country:US
Practice Address - Phone:305-557-4424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-05
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23715225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPTA23715OtherPHYSICAL THERAPY ASSISTANT