Provider Demographics
NPI:1992810782
Name:MOLINO PHYSICAL THERAPY, PLLC
Entity type:Organization
Organization Name:MOLINO PHYSICAL THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAUCHLE
Authorized Official - Suffix:
Authorized Official - Credentials:LPT
Authorized Official - Phone:607-257-7878
Mailing Address - Street 1:2415 NORTH TRIPHAMMER RD
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-257-7878
Mailing Address - Fax:607-257-6526
Practice Address - Street 1:2415 NORTH TRIPHAMMER RD
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-257-7878
Practice Address - Fax:607-257-6526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYAA0912Medicare PIN