Provider Demographics
NPI:1912555384
Name:PATHMAN, MOLLIE ELIZABETH (DPT, CSCS)
Entity Type:Individual
Prefix:
First Name:MOLLIE
Middle Name:ELIZABETH
Last Name:PATHMAN
Suffix:
Gender:F
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 BELLENDEN DR
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-9283
Mailing Address - Country:US
Mailing Address - Phone:919-943-9449
Mailing Address - Fax:
Practice Address - Street 1:3400 WESTGATE DR STE B14C
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-2696
Practice Address - Country:US
Practice Address - Phone:919-943-9449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP18997225100000X, 2251S0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSports
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist