Provider Demographics
NPI:1407417975
Name:RUSNAK, MOLLY MARGARET (PT DPT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:MARGARET
Last Name:RUSNAK
Suffix:
Gender:F
Credentials:PT DPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:MARGARET
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6850 W HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:PALOS HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60463-2134
Mailing Address - Country:US
Mailing Address - Phone:214-500-5924
Mailing Address - Fax:
Practice Address - Street 1:2940 W 95TH ST
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-2408
Practice Address - Country:US
Practice Address - Phone:708-422-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty