Provider Demographics
NPI:1922112283
Name:JARIN, MOLLY JOHANNA (MSPT)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:JOHANNA
Last Name:JARIN
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2516 HAMPSHIRE ROAD
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104
Mailing Address - Country:US
Mailing Address - Phone:734-369-4860
Mailing Address - Fax:734-369-4860
Practice Address - Street 1:180 LITTLE LAKE DRIVE
Practice Address - Street 2:SUITE 4
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103
Practice Address - Country:US
Practice Address - Phone:734-222-7010
Practice Address - Fax:734-222-7010
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5501012824225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist