Individual
MOLLY JO MATHISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.T.
Contact information
Practice address
1910 W 69TH ST, AVERA OUTPATIENT THERAPY CLINIC, SIOUX FALLS, SD 57108-5612
(605) 322-5285
(605) 322-5287
Mailing address
1910 W 69TH ST, AVERA OUTPATIENT THERAPY CLINIC, SIOUX FALLS, SD 57108-5612
(605) 322-5285
(605) 322-5287
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1240
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1649428038
MN BCBS
—
Enumeration date
08/28/2008
Last updated
02/11/2011
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