Provider Demographics
NPI:1518035658
Name:MCKAY, MOLLY MARIE (MPT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:MARIE
Last Name:MCKAY
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MARIE
Other - Last Name:BRUNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:3818 DECKER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1662
Mailing Address - Country:US
Mailing Address - Phone:281-424-7557
Mailing Address - Fax:281-424-7567
Practice Address - Street 1:3818 DECKER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1662
Practice Address - Country:US
Practice Address - Phone:281-424-7557
Practice Address - Fax:281-424-7567
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1139509225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7615482OtherAETNA
TX2073319OtherFIRST HEALTH CCN
TX6362783OtherCIGNA
TX8T1934OtherBLUE CROSS BLUE SHIELD
TX8B4091Medicare ID - Type UnspecifiedBAYTOWN LOCATION ID
TX8B4107Medicare ID - Type UnspecifiedLIBERTY LOCATION ID