Provider Demographics
NPI:1396919023
Name:ROBERT MOLLICA PHYSICAL THERAPY
Entity type:Organization
Organization Name:ROBERT MOLLICA PHYSICAL THERAPY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOLLICA
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:814-765-3970
Mailing Address - Street 1:607 MCBRIDE ST
Mailing Address - Street 2:
Mailing Address - City:CLEARFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:16830-1219
Mailing Address - Country:US
Mailing Address - Phone:814-765-3970
Mailing Address - Fax:814-765-3980
Practice Address - Street 1:607 MCBRIDE ST
Practice Address - Street 2:
Practice Address - City:CLEARFIELD
Practice Address - State:PA
Practice Address - Zip Code:16830-1219
Practice Address - Country:US
Practice Address - Phone:814-765-3970
Practice Address - Fax:814-765-3980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT004049L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172063OtherHIGHMARK BLUE CROSS BLUE
PA172063OtherHIGHMARK BLUE CROSS BLUE