Provider Demographics
NPI:1336347855
Name:MOLINA, PHILIP MARTIN (DPT)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:MARTIN
Last Name:MOLINA
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4971 PERSIMMON LN
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2814
Mailing Address - Country:US
Mailing Address - Phone:714-658-7861
Mailing Address - Fax:
Practice Address - Street 1:2151 N HARBOR BLVD
Practice Address - Street 2:SUITE 3100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3801
Practice Address - Country:US
Practice Address - Phone:714-992-3000
Practice Address - Fax:714-447-6534
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 169712251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedic