Molly Jo Petersen, PTA

Primary specialty

Physical Therapy AssistantTaxonomy code 225200000X

License

PTA1659 Issued in FL

Practice address

2420 NW 115TH Ave
Coral Springs, FL 33065-3422

Phone

(954) 552-4351

NPI assigned

Dec 23, 2008

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229990400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1229990400000",
    "number": "1508002403",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 NW 115TH AVE",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330653422",
            "telephone_number": "954-552-4351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2420 NW 115TH AVE",
            "city": "CORAL SPRINGS",
            "state": "FL",
            "postal_code": "330653422",
            "telephone_number": "954-552-4351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "MOLLY",
        "middle_name": "JO",
        "credential": "PTA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-12-23",
        "last_updated": "2008-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225200000X",
            "taxonomy_group": "",
            "desc": "Physical Therapy Assistant",
            "state": "FL",
            "license": "PTA1659",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pestana Comprehensive Wellness
• Elsa Pestana, MD
• Ivo D Pestana, MD
• Tatiana Angelica Pestana, MD, MPH
• Ronell Thomas Peters, OTR
• Shannon Petersen
• Kylie Petrovich
• Raymond Phenow
• Philip F Averbuch MD PA
• Farah Philippe, APRN

• Physical Therapy Assistant in Coral Springs, FL
• Providers in Coral Springs, FL by specialty
• Physical Therapy Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.