1093607376 NPI number — DR. MOLLY ALLEGRA SHANNON FERENCAK PT, DPT

Table of content: DR. MOLLY ALLEGRA SHANNON FERENCAK PT, DPT (NPI 1093607376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093607376 NPI number — DR. MOLLY ALLEGRA SHANNON FERENCAK PT, DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FERENCAK
Provider First Name:
MOLLY
Provider Middle Name:
ALLEGRA SHANNON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PT, DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHANNON
Provider Other First Name:
MOLLY
Provider Other Middle Name:
ALLEGRA
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT, DPT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093607376
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5115 PARK RD APT 434
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28209-3884
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-668-7526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5115 PARK RD APT 434
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28209-3884
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-668-7526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2025

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  P24145 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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