Basic Information
Provider Information
NPI: 1750309902
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ALBERS
FirstName: MOLLY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: PT
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 13537 BARRETT PARKWAY DRIVE
Address2: SUITE 105
City: BALLWIN
State: MO
PostalCode: 630215896
CountryCode: US
TelephoneNumber: 3148219126
FaxNumber: 3148219142
Practice Location
Address1: 107 CONCORD PLAZA
Address2:  
City: ST. LOUIS
State: MO
PostalCode: 631283521
CountryCode: US
TelephoneNumber: 3148422990
FaxNumber: 3148425162
Other Information
ProviderEnumerationDate: 07/17/2006
LastUpdateDate: 10/06/2010
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
225100000XR1257MOY Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist 

No ID Information.


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