Provider Demographics
NPI:1518222140
Name:MOLINA, ROSELYN G (PT)
Entity Type:Individual
Prefix:
First Name:ROSELYN
Middle Name:G
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8612 BRUNSWICK DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-7387
Mailing Address - Country:US
Mailing Address - Phone:214-618-4342
Mailing Address - Fax:
Practice Address - Street 1:4700 ALLIANCE BLVD
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5323
Practice Address - Country:US
Practice Address - Phone:469-814-2550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1129724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist