Provider Demographics
NPI:1669421947
Name:MOLLURO, ROBERT JR (PT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MOLLURO
Suffix:JR
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S 10TH ST
Mailing Address - Street 2:APT 1-R
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1965
Mailing Address - Country:US
Mailing Address - Phone:215-205-4075
Mailing Address - Fax:
Practice Address - Street 1:220 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-3816
Practice Address - Country:US
Practice Address - Phone:215-985-9390
Practice Address - Fax:215-985-9394
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA007520-L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist