Provider Demographics
NPI:1548516271
Name:MOLINE, ELAINE CRISELDA DEQUINA (PT)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:CRISELDA DEQUINA
Last Name:MOLINE
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ELAINE CRISELDA
Other - Middle Name:QUERO
Other - Last Name:DEQUINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16089 POPPYSEED CIR UNIT 2008
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:302 NOTTINGHAM LN
Practice Address - Street 2:
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375-1809
Practice Address - Country:US
Practice Address - Phone:561-374-4553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-31
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL070017788225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL208325013Medicare PIN
IL208324007Medicare PIN