Provider Demographics
NPI:1952113359
Name:SUTHERLIN, MOLLY (PTA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SUTHERLIN
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 1:371 SW UPPER TERRACE DR STE 3
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97702-1560
Mailing Address - Country:US
Mailing Address - Phone:541-316-0805
Mailing Address - Fax:541-241-7670
Practice Address - Street 1:371 SW UPPER TERRACE DR STE 3
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-1560
Practice Address - Country:US
Practice Address - Phone:541-316-0805
Practice Address - Fax:541-241-7670
Is Sole Proprietor?:No
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10324225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant