Basic Information
| Provider Information | |||||||||
| NPI: | 1578142527 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MOLINA | ||||||||
| FirstName: | SAVANNAH-RAE | ||||||||
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| Credential: | DPT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 86 BOSTON POST RD STE 1 | ||||||||
| Address2: | |||||||||
| City: | WATERFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063852434 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606918960 | ||||||||
| FaxNumber: | 8604441671 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 STONINGTON RD STE A-3 | ||||||||
| Address2: | |||||||||
| City: | MYSTIC | ||||||||
| State: | CT | ||||||||
| PostalCode: | 063552965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8605361699 | ||||||||
| FaxNumber: | 8605361686 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2021 | ||||||||
| LastUpdateDate: | 09/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1342493 | TX | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225100000X | 13724 | CT | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.