Provider Demographics
NPI:1740362060
Name:MOLLICA, ROBERT JOHN (PT)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOHN
Last Name:MOLLICA
Suffix:
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 1:607 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT004049L225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA172063OtherBC/BS GROUP NUMBER
PA463510OtherBC/BS SINGLE PROVIDER #
PA172063OtherBC/BS GROUP NUMBER
PA463510OtherBC/BS SINGLE PROVIDER #