Provider Demographics
NPI:1578244133
Name:KAM, MOLLIE (PT)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:KAM
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 1:555 13TH ST NW STE C112
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20004-1141
Mailing Address - Country:US
Mailing Address - Phone:202-210-1131
Mailing Address - Fax:202-521-3499
Practice Address - Street 1:555 13TH ST NW STE C112
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20004-1141
Practice Address - Country:US
Practice Address - Phone:202-210-1131
Practice Address - Fax:202-521-3499
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPT210002344225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist