Provider Demographics
NPI:1528014180
Name:MOLINA, AIMEE GENE (PT)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:GENE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:GENE
Other - Last Name:SIMIKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2223
Mailing Address - Fax:
Practice Address - Street 1:2320 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60435-6427
Practice Address - Country:US
Practice Address - Phone:815-741-3758
Practice Address - Fax:815-741-3974
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070-006288225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK27224Medicare UPIN
IL205782021Medicare PIN
IL202845086Medicare PIN
IL216860053Medicare PIN