Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | PT7331 | OH |
NPI | 1043416837 |
---|---|
Provider Name | Miss Beth Ann Moeller |
First Address | Canton, OH 44718-2670 |
Second Address | Canton, OH 44708-3121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2007 |
Last Update Date | 08/07/2007 |