Provider Demographics
NPI:1609047190
Name:KROEKER, MOLLY LEE (MSPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:LEE
Last Name:KROEKER
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 PIONEER WOODS DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68506-7562
Mailing Address - Country:US
Mailing Address - Phone:402-488-5122
Mailing Address - Fax:402-488-5166
Practice Address - Street 1:4107 PIONEER WOODS DR
Practice Address - Street 2:SUITE 106
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7562
Practice Address - Country:US
Practice Address - Phone:402-488-5122
Practice Address - Fax:402-488-5166
Is Sole Proprietor?:No
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1885225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist