Provider Demographics
NPI:1457548109
Name:MOLL, DAWNE ELIZABETH (DPT)
Entity type:Individual
Prefix:
First Name:DAWNE
Middle Name:ELIZABETH
Last Name:MOLL
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:D.
Other - Middle Name:
Other - Last Name:MOLL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,PT
Mailing Address - Street 1:3107 WEST COLORADO AVE.
Mailing Address - Street 2:PMB 278
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904
Mailing Address - Country:US
Mailing Address - Phone:719-229-5364
Mailing Address - Fax:719-634-3956
Practice Address - Street 1:3107 WEST COLORADO AVE.
Practice Address - Street 2:PMB 278
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904
Practice Address - Country:US
Practice Address - Phone:719-229-5364
Practice Address - Fax:719-634-3956
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-26
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPT64232251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO32572522Medicaid