Provider Demographics
NPI:1154539609
Name:WINDMILLER, MOLLY ANNE (PTA)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:WINDMILLER
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 1:3043 LUCERNE AVE.
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47725
Mailing Address - Country:US
Mailing Address - Phone:812-626-0536
Mailing Address - Fax:
Practice Address - Street 1:2819 N SAINT JOSEPH AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47720-1335
Practice Address - Country:US
Practice Address - Phone:812-424-2941
Practice Address - Fax:812-423-6230
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06000563A225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant