Individual
MARYALICE MOULDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
37513 BAY HARBOR DR, REHOBOTH BEACH, DE 19971-1584
(302) 367-6699
Mailing address
37513 BAY HARBOR DR, REHOBOTH BEACH, DE 19971-1584
(302) 367-6699
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
J2-0000142
DE
Other
Enumeration date
12/27/2012
Last updated
12/27/2012
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