Provider Demographics
NPI:1174681480
Name:MOE, BARBARA L (MPT)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:MOE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E DALKE AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99208-8112
Mailing Address - Country:US
Mailing Address - Phone:509-483-8228
Mailing Address - Fax:509-483-8338
Practice Address - Street 1:203 E DALKE AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-8112
Practice Address - Country:US
Practice Address - Phone:509-483-8228
Practice Address - Fax:509-483-8338
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPT00008140225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00410141OtherRR MEDICARE
WADB3601OtherRR MEDICARE GROUP
WAG8800296OtherMEDICARE GROUP NUMBER
WAG8800296OtherMEDICARE GROUP NUMBER