Basic Information
| Provider Information | |||||||||
| NPI: | 1104149699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOELTER | ||||||||
| FirstName: | MEGAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 730 CLEVELAND AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551161345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517568525 | ||||||||
| FaxNumber: | 6516991207 | ||||||||
| Practice Location | |||||||||
| Address1: | 730 CLEVELAND AVE S | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551161345 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517568525 | ||||||||
| FaxNumber: | 6516991207 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2010 | ||||||||
| LastUpdateDate: | 08/18/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225700000X | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist |
No ID Information.