Provider Demographics
NPI:1427518034
Name:ABOUZEDAN, MOLLIE ANN (DPT)
Entity type:Individual
Prefix:MRS
First Name:MOLLIE
Middle Name:ANN
Last Name:ABOUZEDAN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1929 EDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:IN
Mailing Address - Zip Code:46360-1405
Mailing Address - Country:US
Mailing Address - Phone:219-309-5622
Mailing Address - Fax:
Practice Address - Street 1:1120 S CALUMET RD STE 3
Practice Address - Street 2:
Practice Address - City:CHESTERTON
Practice Address - State:IN
Practice Address - Zip Code:46304-3286
Practice Address - Country:US
Practice Address - Phone:219-983-9675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN05013579A225100000X
ND2253225100000X
CA296465225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist