Provider Demographics
NPI:1467177048
Name:MOEHLING, BRIANNA ROSE
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:ROSE
Last Name:MOEHLING
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1552 COUNTRY CLUB PLAZA DR # 1570
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3859
Mailing Address - Country:US
Mailing Address - Phone:224-330-9856
Mailing Address - Fax:
Practice Address - Street 1:1552 COUNTRY CLUB PLAZA DR # 1570
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3859
Practice Address - Country:US
Practice Address - Phone:636-724-1127
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-06
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022028264225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist