Provider Demographics
NPI:1659509040
Name:MOLIDOR, MICHELINE ROSE (PT)
Entity Type:Individual
Prefix:MISS
First Name:MICHELINE
Middle Name:ROSE
Last Name:MOLIDOR
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 1:7939 MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3617
Mailing Address - Country:US
Mailing Address - Phone:214-208-8614
Mailing Address - Fax:
Practice Address - Street 1:7939 MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3617
Practice Address - Country:US
Practice Address - Phone:214-208-8614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT24725225100000X
WAPT60994978225100000X
TX1195456225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist