Provider Demographics
NPI:1124708193
Name:MOLEN, STEPHEN (LMT)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MOLEN
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:314 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-2506
Mailing Address - Country:US
Mailing Address - Phone:406-454-0438
Mailing Address - Fax:406-727-8550
Practice Address - Street 1:314 1ST AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-2506
Practice Address - Country:US
Practice Address - Phone:406-454-0438
Practice Address - Fax:406-727-8550
Is Sole Proprietor?:No
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT650225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist