Provider Demographics
NPI:1497095137
Name:STEIN, MOLLY (LMT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:STEIN
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 420
Mailing Address - Street 2:
Mailing Address - City:BRIGHTWOOD
Mailing Address - State:OR
Mailing Address - Zip Code:97011-0420
Mailing Address - Country:US
Mailing Address - Phone:503-724-2993
Mailing Address - Fax:
Practice Address - Street 1:24540 E WELCHES RD
Practice Address - Street 2:
Practice Address - City:WELCHES
Practice Address - State:OR
Practice Address - Zip Code:97067-0347
Practice Address - Country:US
Practice Address - Phone:503-564-9364
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-16
Last Update Date:2013-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR13578172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172M00000XOther Service ProvidersMechanotherapist