Provider Demographics
NPI:1467682047
Name:MOELLER, MICHELLE KAY (DPT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAY
Last Name:MOELLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KAY
Other - Last Name:ISAACSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPT
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-643-7555
Mailing Address - Fax:515-643-7560
Practice Address - Street 1:800 E 1ST ST
Practice Address - Street 2:SUITE W270
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2077
Practice Address - Country:US
Practice Address - Phone:515-643-7555
Practice Address - Fax:515-643-7560
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA4405225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19172017Medicare PIN
IAI19172Medicare PIN