Provider Demographics
NPI:1568298834
Name:RODEBAUGH, MOLLY KATE (ATC)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:KATE
Last Name:RODEBAUGH
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 CAROUSEL CIR
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:PA
Mailing Address - Zip Code:18901-5031
Mailing Address - Country:US
Mailing Address - Phone:267-471-9572
Mailing Address - Fax:
Practice Address - Street 1:372 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-3924
Practice Address - Country:US
Practice Address - Phone:610-688-8807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PART0085042255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer