Provider Demographics
NPI:1881234680
Name:MOLTER, EMILY KIM (PTA)
Entity type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:KIM
Last Name:MOLTER
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 N CAMDEN LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60177-2849
Mailing Address - Country:US
Mailing Address - Phone:630-677-1622
Mailing Address - Fax:
Practice Address - Street 1:1058 N CAMDEN LN
Practice Address - Street 2:
Practice Address - City:SOUTH ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60177-2849
Practice Address - Country:US
Practice Address - Phone:630-677-1622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-09
Last Update Date:2020-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant