Provider Demographics
NPI:1275763534
Name:MOEN, ADAM (PT)
Entity Type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:MOEN
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W 69TH ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-2438
Mailing Address - Country:US
Mailing Address - Phone:605-331-0044
Mailing Address - Fax:605-331-0088
Practice Address - Street 1:101 W 69TH ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-2438
Practice Address - Country:US
Practice Address - Phone:605-331-0044
Practice Address - Fax:605-331-0088
Is Sole Proprietor?:No
Enumeration Date:2009-07-21
Last Update Date:2009-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1469225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist