Provider Demographics
NPI:1386937597
Name:RAAB, MOLLY JEANNE
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:JEANNE
Last Name:RAAB
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:N5596 COUNTY ROAD B
Mailing Address - Street 2:
Mailing Address - City:DEERBROOK
Mailing Address - State:WI
Mailing Address - Zip Code:54424-9310
Mailing Address - Country:US
Mailing Address - Phone:906-281-5019
Mailing Address - Fax:
Practice Address - Street 1:5700 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53220-4016
Practice Address - Country:US
Practice Address - Phone:414-281-7220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-20
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1644-19225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant