Provider Demographics
NPI:1750621660
Name:BOROUGHS, MOLLY (PTA)
Entity type:Individual
Prefix:MRS
First Name:MOLLY
Middle Name:
Last Name:BOROUGHS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:DEWEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PTA
Mailing Address - Street 1:195 S PENNSYLVANIA ST
Mailing Address - Street 2:APT 306
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-1957
Mailing Address - Country:US
Mailing Address - Phone:703-728-8612
Mailing Address - Fax:
Practice Address - Street 1:195 S PENNSYLVANIA ST
Practice Address - Street 2:APT 306
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80209-1957
Practice Address - Country:US
Practice Address - Phone:703-728-8612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTA.0012706225200000X
COMT.0012105225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist