| NPI | 1588915797 |
|---|---|
| Former Name | MOLLY MARIE LODER |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 4376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6966) |
| Enumeration Date | 2012-09-27 |
| Last Update Date | 2017-04-20 |