Provider Demographics
NPI:1568349256
Name:DENNIE, MOLLY (PT, DPT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:DENNIE
Suffix:
Gender:F
Credentials:PT, DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 W MELROSE ST APT 447
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3739
Mailing Address - Country:US
Mailing Address - Phone:317-529-8917
Mailing Address - Fax:
Practice Address - Street 1:1725 W HARRISON ST STE 440
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3836
Practice Address - Country:US
Practice Address - Phone:312-563-2454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-16
Last Update Date:2025-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070.027152225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist