Provider Demographics
NPI:1871815332
Name:MOLINA, JONAS RAFAEL (PT)
Entity Type:Individual
Prefix:MR
First Name:JONAS
Middle Name:RAFAEL
Last Name:MOLINA
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 GOLDENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61821-3430
Mailing Address - Country:US
Mailing Address - Phone:217-359-0279
Mailing Address - Fax:
Practice Address - Street 1:704 GOLDENVIEW DR
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61821-3430
Practice Address - Country:US
Practice Address - Phone:217-359-0279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070014429225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist