Provider Demographics
NPI:1356763866
Name:WELLINGHOFF, MOLLY (DPT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:WELLINGHOFF
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 IDLEWILD RD
Mailing Address - Street 2:3A
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-4030
Mailing Address - Country:US
Mailing Address - Phone:410-713-2378
Mailing Address - Fax:
Practice Address - Street 1:1401 CONOWINGO RD
Practice Address - Street 2:SUITE C
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-1809
Practice Address - Country:US
Practice Address - Phone:410-420-2257
Practice Address - Fax:410-420-2267
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2014-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24862225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist