Provider Demographics
NPI:1821447814
Name:REIDY, MOLLIE (DPT)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:REIDY
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLIE
Other - Middle Name:
Other - Last Name:RINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2736 S ADAMS ST
Mailing Address - Street 2:UNIT 1
Mailing Address - City:SOUTH SALT LAKE
Mailing Address - State:UT
Mailing Address - Zip Code:84115-3376
Mailing Address - Country:US
Mailing Address - Phone:616-240-1394
Mailing Address - Fax:
Practice Address - Street 1:9660 S 1300 E
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3762
Practice Address - Country:US
Practice Address - Phone:801-501-2262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-09
Last Update Date:2016-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9733920-2401225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist