Provider Demographics
NPI:1346528304
Name:MOEN, LINDSAY TESSA (DPT)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:TESSA
Last Name:MOEN
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9680 TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2622
Mailing Address - Country:US
Mailing Address - Phone:651-702-3565
Mailing Address - Fax:763-389-6410
Practice Address - Street 1:9680 TAMARACK RD
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-2622
Practice Address - Country:US
Practice Address - Phone:651-702-3565
Practice Address - Fax:763-389-6410
Is Sole Proprietor?:No
Enumeration Date:2011-07-25
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN8800225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist