Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251N0400X | Physical Therapist - Neurology | 1197540 | TX |
NPI | 1043604846 |
---|---|
Provider Name | Janet Moeller |
First Address | Dallas, TX 75390-9055 |
Second Address | Dallas, TX 75390-9055 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2015 |
Last Update Date | 19/03/2015 |