Provider Demographics
NPI:1336230283
Name:MOLENDIJK, JOHANNA ANJA (PT)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:ANJA
Last Name:MOLENDIJK
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10345 PARKGLENN WAY
Mailing Address - Street 2:SUITE 220
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-3883
Mailing Address - Country:US
Mailing Address - Phone:303-840-9202
Mailing Address - Fax:
Practice Address - Street 1:10345 PARKGLENN WAY
Practice Address - Street 2:SUITE 220
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3883
Practice Address - Country:US
Practice Address - Phone:303-840-9202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPT 7431225100000X
CO10991174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10991OtherSTATE LICENSE
FLPT7431OtherLICENSE