Provider Demographics
NPI:1356425714
Name:MOLINA, VIKKI MICHELE (PT)
Entity type:Individual
Prefix:MS
First Name:VIKKI
Middle Name:MICHELE
Last Name:MOLINA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MRS
Other - First Name:VIKKI
Other - Middle Name:MICHELE
Other - Last Name:FARIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPT
Mailing Address - Street 1:PO BOX 720157
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0157
Mailing Address - Country:US
Mailing Address - Phone:956-682-6900
Mailing Address - Fax:956-682-8445
Practice Address - Street 1:1002 W SAM HOUSTON
Practice Address - Street 2:SUITE 10
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-5198
Practice Address - Country:US
Practice Address - Phone:956-702-9882
Practice Address - Fax:956-702-9886
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11409452251P0200X, 225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
No2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162550101Medicaid