Provider Demographics
NPI:1841406345
Name:LICARI, MOLLY A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:A
Last Name:LICARI
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MISS
Other - First Name:MOLLY
Other - Middle Name:A
Other - Last Name:WALTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:37 ANNETTE AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-3943
Mailing Address - Country:US
Mailing Address - Phone:516-223-3130
Mailing Address - Fax:516-223-3130
Practice Address - Street 1:187 VETERANS BLVD UNIT B
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-4979
Practice Address - Country:US
Practice Address - Phone:516-826-9825
Practice Address - Fax:516-679-1466
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY16565-1225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYQ182C1OtherEMPIRE BLUE CROSS BLUE SHIELD