Provider Demographics
NPI:1548399116
Name:MOLBECK, VICTORIA LJ (PT)
Entity Type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:LJ
Last Name:MOLBECK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4 AMBERLEIGH CT
Mailing Address - Street 2:
Mailing Address - City:LAKE IN THE HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60156-5840
Mailing Address - Country:US
Mailing Address - Phone:847-669-8161
Mailing Address - Fax:847-669-8162
Practice Address - Street 1:4 AMBERLEIGH CT
Practice Address - Street 2:
Practice Address - City:LAKE IN THE HILLS
Practice Address - State:IL
Practice Address - Zip Code:60156-5840
Practice Address - Country:US
Practice Address - Phone:847-669-8161
Practice Address - Fax:847-669-8162
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist