Provider Demographics
NPI:1629667654
Name:CLEVELAND, MOLLY LIANNE (DPT)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:LIANNE
Last Name:CLEVELAND
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:LIANNE
Other - Last Name:KOENEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 5718
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59903-5718
Mailing Address - Country:US
Mailing Address - Phone:406-756-0134
Mailing Address - Fax:406-300-1612
Practice Address - Street 1:5980 STETSON HILLS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3633
Practice Address - Country:US
Practice Address - Phone:719-574-3111
Practice Address - Fax:719-574-2912
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPTL.0018199225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist