Provider Demographics
NPI:1720237415
Name:MOLEN, CHAD L (DPT, CSCS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:L
Last Name:MOLEN
Suffix:
Gender:M
Credentials:DPT, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 8TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-2165
Mailing Address - Country:US
Mailing Address - Phone:406-454-0438
Mailing Address - Fax:406-727-8550
Practice Address - Street 1:314 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2506
Practice Address - Country:US
Practice Address - Phone:406-454-0438
Practice Address - Fax:406-727-8550
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2163225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2163OtherLICENCE NUMBER