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Individual
MOLLIE BASIC
Active
Individual
MOLLIE BASIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPT
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00994444
MCRR
IL
Enumeration date
06/28/2011
Last updated
11/09/2012
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