Provider Demographics
NPI:1104229095
Name:EHRHARDT, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:EHRHARDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 DANFORTH DR APT 406
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5220
Mailing Address - Country:US
Mailing Address - Phone:727-504-5003
Mailing Address - Fax:
Practice Address - Street 1:9000 CYPRESS GREEN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7791
Practice Address - Country:US
Practice Address - Phone:904-732-4343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist