Provider Demographics
NPI:1952482978
Name:MALLOY, MOLLY (PT, OCS)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:MALLOY
Suffix:
Gender:F
Credentials:PT, OCS
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANNE
Other - Last Name:SCANLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT, OCS
Mailing Address - Street 1:790 REMINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4909
Mailing Address - Country:US
Mailing Address - Phone:630-296-2222
Mailing Address - Fax:630-759-9510
Practice Address - Street 1:44 W SKIPPACK PIKE
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-5138
Practice Address - Country:US
Practice Address - Phone:267-419-2020
Practice Address - Fax:215-646-4062
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCOPT7241225100000X
PAPT027724225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist