Individual
MOLLY MATTINGLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1273 N EMERSON AVE, SUITE E, GREENWOOD, IN 46143-6672
(317) 807-0770
(317) 807-0771
Mailing address
625 ENTERPRISE DR, OAK BROOK, IL 60523-8813
(630) 575-1980
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
05006668A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100133720K
—
IN
Enumeration date
01/24/2007
Last updated
04/25/2017
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