Provider Demographics
NPI:1558617043
Name:MOELLER, KRISTEN MARIE (DPT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:MOELLER
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:KRSTEN
Other - Middle Name:
Other - Last Name:LIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-7651
Practice Address - Street 1:6480 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45247-7961
Practice Address - Country:US
Practice Address - Phone:513-354-7777
Practice Address - Fax:513-354-7778
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT013705225100000X
SC7268225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01386375OtherRAILROAD MEDICARE PROFESSIONAL REHABILITATION SERVICES INC
SCP01386567OtherRAILROAD MEDICARE PRS II LLC
SC7268OtherSC LICENSE
SCTH2825Medicaid
OH0476719Medicaid
SCP01386414OtherRAILROAD MEDICARE PRS 4 LLC
SCQ46254C630Medicare PIN
SCTH2825Medicaid
SCQ46254E293Medicare PIN
SCQ46254A382Medicare PIN
SCQ462547906Medicare PIN