Provider Demographics
NPI:1750377248
Name:MOLEN, REID L JR (PT)
Entity type:Individual
Prefix:MR
First Name:REID
Middle Name:L
Last Name:MOLEN
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 1:2001 11TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3409
Mailing Address - Country:US
Mailing Address - Phone:406-454-0579
Mailing Address - Fax:
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:2005-09-21
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT105054-2401225100000X
CA9141225100000X
MT86PT225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT196546100OtherUS DEPT. OF LABOR
MT942822815B004OtherTRICARE
MT0349154Medicaid
MT942822815003OtherEBMS
MT000083326OtherMEDICARE - GROUP NUMBER