Provider Demographics
NPI:1629464755
Name:MOLLOY, JOY (PTA)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:MOLLOY
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-3904
Mailing Address - Country:US
Mailing Address - Phone:870-394-7000
Mailing Address - Fax:870-394-7001
Practice Address - Street 1:1218 STONE ST STE 140
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4568
Practice Address - Country:US
Practice Address - Phone:870-336-0220
Practice Address - Fax:870-558-5637
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-15
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPTA 3926225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR207745721Medicaid