Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2251E1200X | Ergonomics | 11-04980 | KS |
N | 225XE1200X | Ergonomics | 11-04980 | KS |
N | 2251G0304X | Physical Therapist - Geriatrics | 11-04980 | KS |
Y | 2251X0800X | Physical Therapist - Orthopedic | 11-04980 | KS |
NPI | 1245725316 |
---|---|
Provider Name | Ashley Moeder |
First Address | La Crosse, KS 67548-9625 |
Second Address | Plainville, KS 67663-1632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 29/06/2018 |