Provider Demographics
NPI:1336543743
Name:ROFFMAN, MOLLY OLIVIA (PT MA CEEAA)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:OLIVIA
Last Name:ROFFMAN
Suffix:
Gender:F
Credentials:PT MA CEEAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 S HIGHLAND AVE STE 109
Mailing Address - Street 2:
Mailing Address - City:BRIARCLIFF MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10510-2096
Mailing Address - Country:US
Mailing Address - Phone:914-292-0602
Mailing Address - Fax:
Practice Address - Street 1:325 S HIGHLAND AVE STE 109
Practice Address - Street 2:
Practice Address - City:BRIARCLIFF MANOR
Practice Address - State:NY
Practice Address - Zip Code:10510-2096
Practice Address - Country:US
Practice Address - Phone:914-486-8125
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2020-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
NY001586225100000X
NY011586-12251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist