Provider Demographics
NPI:1043416837
Name:MOELLER, BETH ANN (PT)
Entity Type:Individual
Prefix:MISS
First Name:BETH
Middle Name:ANN
Last Name:MOELLER
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4108 TANNYBROOKE LN NW
Mailing Address - Street 2:UNIT C
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2670
Mailing Address - Country:US
Mailing Address - Phone:330-493-3116
Mailing Address - Fax:
Practice Address - Street 1:2714 13TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-3121
Practice Address - Country:US
Practice Address - Phone:330-456-2842
Practice Address - Fax:330-456-5343
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT73312251G0304X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251G0304XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGeriatrics