Provider Demographics
NPI:1316347156
Name:NEWMAN, MOLLIE (ATC, PT, DPT)
Entity type:Individual
Prefix:
First Name:MOLLIE
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:ATC, PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 E LINCOLNWAY
Mailing Address - Street 2:
Mailing Address - City:MINERVA
Mailing Address - State:OH
Mailing Address - Zip Code:44657-1214
Mailing Address - Country:US
Mailing Address - Phone:330-868-4362
Mailing Address - Fax:
Practice Address - Street 1:7735 STATE ROUTE 45
Practice Address - Street 2:
Practice Address - City:LISBON
Practice Address - State:OH
Practice Address - Zip Code:44432-8342
Practice Address - Country:US
Practice Address - Phone:330-424-9033
Practice Address - Fax:330-424-9053
Is Sole Proprietor?:No
Enumeration Date:2014-08-29
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2255A2300X
OHPT018822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0447682Medicaid